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Economic Evaluation of Complete Revascularization for Patients with Multivessel Disease Undergoing Primary

Garry R Barton1, Lisa Irvine1, Marcus Flather1

  • 1Norwich Medical School, University of East Anglia, Norwich, UK.

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
|June 5, 2017
PubMed

Insights

Complete revascularization during ST-segment elevation myocardial infarction is more effective and cost-effective than treating only the infarct-related artery. This approach reduces major adverse cardiac events and hospital costs, offering better patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Interventional Cardiology

Background:

  • ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease often require percutaneous coronary intervention (P-PCI).
  • The optimal revascularization strategy, complete versus infarct-related artery (IRA) only, remains an area of economic and clinical evaluation.

Purpose of the Study:

  • To determine the cost-effectiveness of complete revascularization versus IRA-only P-PCI in STEMI patients with multivessel disease.
  • To compare major adverse cardiac events (MACEs) and quality-adjusted life-years (QALYs) between the two strategies.

Main Methods:

  • Economic evaluation of a multicenter randomized trial with 12-month follow-up.
  • Estimation of overall hospital costs, including P-PCI procedures, hospital stay, and re-admissions.
  • Assessment of MACEs and QALYs using the EuroQol five-dimensional questionnaire.

Main Results:

  • Complete revascularization was associated with a mean cost reduction of -£215.96 and a reduction of 0.170 MACEs per patient.
  • A gain of 0.011 QALYs was observed with complete revascularization.
  • The probability of complete revascularization being cost-effective was 72.0% at a willingness-to-pay threshold of £20,000 per QALY.

Conclusions:

  • Complete revascularization at index admission is more effective and cost-effective for STEMI patients with multivessel disease.
  • This strategy dominates IRA-only treatment, showing lower costs and improved clinical outcomes.
  • While the results suggest a clear benefit, some uncertainty remains in the decision-making process.
Abstract

Keywords:
economic evaluationmyocardial infarctionpercutaneous coronary interventionrevascularization

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