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Cardiovasc Ther. 2018 Oct;36(5):e12442. doi: 10.1111/1755-5922.12442. Epub 2018 Jun 28.

Cost-effectiveness analysis of biodegradable polymer versus durable polymer drug-eluting stents incorporating real-world evidence.

Author information

1
Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore.
2
Department of Cardiology, National University Heart Centre, Singapore, Singapore.
3
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abstract

AIM:

Compared with second-generation durable polymer drug-eluting stents (DP-DES), the cost-effectiveness of biodegradable polymer drug-eluting stents (BP-DES) remains unclear in the real-world setting. We assessed the cost-effectiveness of BP-DES in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI).

METHODS:

We developed a decision-analytic model to compare the cost-effectiveness of BP-DES to DP-DES over 1 year and 5 years from healthcare payer perspective. Relative treatment effects during the first year post-PCI were obtained from a real-world population analysis while clinical event risks in the subsequent 4 years were derived from a meta-analysis of published studies.

RESULTS:

At 1 year, based on the clinical data analysis of 497 propensity-score matched pairs of patients, BP-DES were associated with an incremental cost-effectiveness ratio (ICER) of USD20 503 per quality-adjusted life-year (QALY) gained. At 5 years, BP-DES yielded an ICER of USD4062 per QALY gained. At the willingness-to-pay threshold of USD50 400 (one gross domestic product per capita in Singapore in 2015), BP-DES were cost-effective. Sensitivity analysis showed that the cost of stents had a significant impact on the cost-effectiveness of BP-DES. Threshold analysis demonstrated that if the cost difference between BP-DES and DP-DES exceeded USD493, BP-DES would not be cost-effective in patients with 1 year of follow-up.

CONCLUSIONS:

Biodegradable polymer drug-eluting stents were cost-effective compared with DP-DES in patients with coronary artery disease at 1 year and 5 years after PCI. It is worth noting that the cost of stents had a significant impact on the findings.

KEYWORDS:

biodegradable polymer; coronary artery disease; cost-effectiveness analysis; drug-eluting stents; percutaneous coronary intervention

PMID:
29873191
DOI:
10.1111/1755-5922.12442
[Indexed for MEDLINE]

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