Cost-Utility Analysis of Different Treatment Modalities in Patients Undergoing Percutaneous Coronary Intervention:...

Cost-utility analyses of percutaneous coronary interventions (PCIs) provide valuable insights into the economic value of these procedures. However, data is lacking, particularly in developing countries with limited resources.

This analysis aimed to compare the cost-utility of different treatment modalities used for PCI patients within a Thai PCI registry.

Clinical and quality-of-life data from 39 hospitals spread throughout Thailand were used in this analysis. Three treatment modalities for PCI procedures were compared: (a) radial versus femoral access, (b) partial versus complete revascularization for multivessel coronary artery disease, and (c) use versus non-use of device-guided PCIs (intracoronary ultrasound, optical coherence tomography, or fractional flow reserve). Cost data were obtained from each patient's bill for their hospital stay. Utility scores were measured using the Thai EQ-5D-5L at admission, discharge, and 1-year postprocedure. The incremental cost-effectiveness ratio (ICER) was then estimated and used for each comparison.

Of 19,701 patients enrolled in 2018-19, approximately one-third (n = 7332) had hospital cost data available for analysis. At discharge, the mean costs associated with radial access and partial revascularization were $986 and $391, respectively, less than the costs for device-guided PCIs, which increased by a mean of $2004. The delta utility gains for these approaches were 2.97, 1.60, and 1.07 at discharge and 1.08, 1.06, and 0.29 at 1 year, respectively. The estimated ICERs at 1 year were -$894, -$359, and $7041 per unit of utility gained, respectively.

Radial access and partial revascularization are cost-effective PCI strategies, while lesion severity assessment devices incur high costs per unit of utility gained. Identifying the factors that influence these outcomes may assist clinicians in tailoring interventions to optimize a patient's quality of life after PCI.