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Cost-effectiveness analysis of pressure-controlled intermittent coronary sinus occlusion in elective percutaneous
Carla Rognoni1, Gaia Segantin1, Roberto Scarsini2
1Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.
Insights
Percutaneous coronary intervention with Pressure-controlled intermittent coronary sinus occlusion (PCI+PiCSO) is a cost-effective treatment for ST-elevated myocardial infarction. This innovative approach improves patient outcomes and quality of life compared to standard PCI alone.
Area of Science:
- Cardiology
- Health Economics
Background:
- Percutaneous coronary intervention (PCI) is standard for ST-elevated myocardial infarction but has frequent mortality and heart failure.
- Pressure-controlled intermittent coronary sinus occlusion (PiCSO) may reduce infarct size and improve patient outcomes.
Purpose of the Study:
- To evaluate the cost-effectiveness of PCI plus PiCSO compared to PCI alone from the Italian National Healthcare Service (NHS) perspective.
- To assess the impact of PCI+PiCSO on life years (LYs) and quality-adjusted life years (QALYs).
Main Methods:
- A Markov model was developed to estimate LYs, QALYs, and costs.
- A micro-costing analysis determined the cost of the PCI+PiCSO procedure.
- Sensitivity analyses were conducted to ensure model robustness.
Main Results:
- PCI+PiCSO demonstrated an ICUR of €17,530/QALY and an ICER of €14,631/LY, suggesting cost-effectiveness.
- The strategy was found to be cost-effective in 78.8% of simulations.
- PCI+PiCSO is cost-effective if its procedure cost is below €28,160.
Conclusions:
- PCI+PiCSO is a potentially cost-effective technology for managing ST-elevated myocardial infarction.
- The procedure may reduce cardiac events and enhance patients' life expectancy and quality of life.
Objectives:
Percutaneous coronary intervention (PCI) represents the standard treatment for ST-elevated myocardial infarction, nevertheless, mortality and heart failures are frequent. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) might reduce infarct size showing better patients' outcomes. We evaluated the cost-effectiveness of PCI+PiCSO compared to PCI from the National Healthcare Service (NHS) perspective in Italy.
Methods:
A Markov model was developed to estimate life years (LYs), quality-adjusted life years (QALYs) and costs. A micro-costing analysis has been performed to inform the cost of PCI+PiCSO procedure. Sensitivity analyses were performed to test the robustness of the model results.
Results:
Considering a willingness-to-pay threshold of 50,000€/QALY for the ICUR and a cost for PCI+PiCSO procedure of 14,654€, the innovative strategy may be cost-effective compared to PCI alone from the Italian NHS perspective, showing an ICUR of 17,530€/QALY (ICER 14,631€/LY) over a lifetime horizon; the probabilistic sensitivity analysis showed that PCI+PiCSO is cost-effective in 78.8% of simulations.Considering the above mentioned willingness-to-pay threshold, PCI+PiCSO strategy would be cost-effective over a lifetime horizon considering a cost for PCI+PiCSO procedure lower than 28,160€.
Conclusion:
PCI+PiCSO procedure may be considered a cost-effective technology that allows reducing cardiac events, while improving patients' life expectancy and quality of life.
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