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Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in

Satoshi Kodera1, Hiroyuki Morita1, Arihiro Kiyosue1

  • 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 7, 2019
PubMed

Insights

Percutaneous coronary intervention (PCI) is cost-effective for ST-elevation myocardial infarction (STEMI) in Japan. For angina pectoris (AP), fractional flow reserve (FFR)-guided PCI is cost-effective for symptomatic patients but not for asymptomatic ones.

Area of Science:

  • Health Economics
  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • The cost-effectiveness of percutaneous coronary intervention (PCI) for ischemic heart disease in Japan remains unclear.
  • This study aimed to evaluate the economic value of PCI versus medical therapy for ST-elevation myocardial infarction (STEMI) and angina pectoris (AP).

Purpose of the Study:

  • To analyze the cost-effectiveness of PCI compared to medical therapy for STEMI and AP in Japan.
  • To determine the economic viability of PCI based on health system perspective and quality-adjusted life-years (QALYs).

Main Methods:

  • Markov models were utilized to assess costs and benefits of PCI versus medical therapy for STEMI and AP.
  • Incremental Cost-Effectiveness Ratio (ICER) was calculated, with a threshold of ¥5 million per QALY gained considered cost-effective.
  • Data on PCI's impact on cardiovascular events were derived from existing literature.

Main Results:

  • For STEMI patients, PCI demonstrated a cost-effectiveness of ¥0.97 million per QALY gained, with a 99.9% probability of being cost-effective.
  • For symptomatic AP patients, FFR-guided PCI yielded an ICER of ¥4.63 million per QALY gained, with a 50.4% cost-effectiveness probability.
  • FFR-guided PCI for asymptomatic patients with myocardial ischemia was not cost-effective, with an ICER of ¥23 million per QALY gained.

Conclusions:

  • PCI is a cost-effective treatment option for STEMI patients in Japan compared to medical therapy.
  • FFR-guided PCI may be a cost-effective strategy for symptomatic AP patients but not for asymptomatic individuals with myocardial ischemia.
Abstract

Keywords:
AnginaIncremental cost-effectiveness ratioMyocardial infarctionPercutaneous coronary interventionQuality-adjusted life-year

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