Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI: Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial
David Hong1, Jin Lee2,3, Hankil Lee4
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.).
Insights
Intravascular imaging-guided percutaneous coronary intervention (PCI) is cost-effective for complex coronary artery lesions. This strategy reduces long-term medical costs and improves quality-adjusted life years (QALYs).
Area of Science:
- Cardiology
- Health Economics
- Medical Technology Assessment
Background:
- Clinical benefits of intravascular imaging-guided PCI for complex coronary artery lesions are known.
- Cost-effectiveness of this strategy remains uncertain.
- The RENOVATE-COMPLEX-PCI trial provides data for this cost-effectiveness analysis.
Purpose of the Study:
- To evaluate the cost-effectiveness of intravascular imaging-guided PCI compared to angiography-guided PCI.
- To analyze costs and quality-adjusted life years (QALYs) over 3-year and lifetime horizons.
- To determine the incremental cost-effectiveness ratio (ICER) using a Markov model.
Main Methods:
- A Markov model simulated post-PCI, myocardial infarction, and death states.
- Data from the RENOVATE-COMPLEX-PCI trial (intention-to-treat population) were used.
- Cost-effectiveness was assessed from the Korean healthcare perspective, with a willingness-to-pay threshold of $35,000 per QALY.
Main Results:
- Within 3 years, imaging-guided PCI had higher costs ($1426) and QALYs (0.025), with an ICER of $57,040/QALY.
- Lifetime simulation showed imaging-guided PCI was dominant, with lower costs (-$9063) and higher QALYs (0.910).
- Probabilistic sensitivity analysis indicated a 70% likelihood of cost-effectiveness for imaging-guided PCI.
Conclusions:
- Intravascular imaging-guided PCI is more cost-effective than angiography-guided PCI for complex coronary artery lesions in the long term.
- This strategy reduces medical costs and enhances quality of life.
- The findings support the adoption of imaging guidance for complex PCI procedures.
Background:
Although clinical benefits of intravascular imaging-guided percutaneous coronary intervention (PCI) in patients with complex coronary artery lesions have been observed in previous trials, the cost-effectiveness of this strategy is uncertain.
Methods:
RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance vs Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) was conducted in Korea between May 2018 and May 2021. This prespecified cost-effectiveness substudy was conducted using Markov model that simulated 3 states: (1) post-PCI, (2) spontaneous myocardial infarction, and (3) death. A simulated cohort was derived from the intention-to-treat population, and input parameters were extracted from either the trial data or previous publications. Cost-effectiveness was evaluated using time horizon of 3 years (within trial) and lifetime. The primary outcome was incremental cost-effectiveness ratio (ICER), an indicator of incremental cost on additional quality-adjusted life years (QALYs) gained, in intravascular imaging-guided PCI compared with angiography-guided PCI. The current analysis was performed using the Korean health care sector perspective with reporting the results in US dollar (1200 Korean Won, ₩=1 dollar, $). Willingness to pay threshold was $35 000 per QALY gained.
Results:
A total of 1639 patients were included in the trial. During 3-year follow-up, medical costs ($8661 versus $7236; incremental cost, $1426) and QALY (2.34 versus 2.31; incremental QALY, 0.025) were both higher in intravascular imaging-guided PCI than angiography-guided PCI, resulting incremental cost-effectiveness ratio of $57 040 per QALY gained within trial data. Conversely, lifetime simulation showed total cumulative medical cost was reversed between the 2 groups ($40 455 versus $49 519; incremental cost, -$9063) with consistently higher QALY (8.24 versus 7.89; incremental QALY, 0.910) in intravascular imaging-guided PCI than angiography-guided PCI, resulting in a dominant incremental cost-effectiveness ratio. Consistently, 70% of probabilistic iterations showed cost-effectiveness of intravascular imaging-guided PCI in probabilistic sensitivity analysis.
Conclusions:
The current cost-effectiveness analysis suggests that imaging-guided PCI is more cost-effective than angiography-guided PCI by reducing medical cost and increasing quality-of-life in complex coronary artery lesions in long-term follow-up.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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