Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction: Cost-Effectiveness Analysis of the
Carlos Chivardi1, Holly Morgan2, Mark J Sculpher1
1Centre for Health Economics, University of York, United Kingdom (C.C., M.J.S., P.S.).
Insights
Percutaneous coronary intervention (PCI) did not prove cost-effective for ischemic left ventricular dysfunction, despite initial quality of life improvements. The study found PCI offered similar health benefits but at a significantly higher cost than optimal medical therapy alone.
Area of Science:
- Cardiology
- Health Economics
Background:
- Percutaneous coronary intervention (PCI) is common for ischemic left ventricular systolic dysfunction.
- The REVIVED-BCIS2 trial showed PCI did not reduce mortality or heart failure hospitalizations.
- However, PCI improved initial quality of life compared to optimal medical therapy (OMT) alone.
Purpose of the Study:
- To assess the cost-effectiveness of PCI plus OMT versus OMT alone in patients with ischemic left ventricular systolic dysfunction.
Main Methods:
- A prospective, multicenter UK trial randomized 700 patients to PCI+OMT or OMT alone.
- Health care resource use and quality-adjusted life-years (QALYs) were tracked up to 8 years.
- Costs were analyzed from a UK health system perspective.
Main Results:
- PCI+OMT resulted in similar QALYs (4.14) but higher costs (£22,352) compared to OMT alone (4.16 QALYs, £15,569).
- The incremental cost-effectiveness ratio favored OMT alone.
- The probability of PCI being cost-effective was negligible.
Conclusions:
- PCI+OMT is not cost-effective compared to OMT alone for ischemic left ventricular systolic dysfunction.
- Routine PCI for this condition is not a justifiable use of UK healthcare resources.
Background:
Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone.
Methods:
REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors.
Results:
Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: -0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0.
Conclusions:
A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920048.
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