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.).
Circulation. Cardiovascular Quality and Outcomes
|March 13, 2024
Summary
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.
Keywords:
coronary artery diseasehealth care sectormyocardial infarctionpercutaneous coronary interventionquality of lifeMore Related Videos
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