RESUMEN
OBJECTIVES: The study estimated the health economic impact of a latest generation coronary stent with ultrathin struts and bioresorbable polymer coating. BACKGROUND: The recent BIOFLOW V trial, an international FDA approval trial (ClinicalTrials.gov: NCT02389946), has shown that an ultrathin, bioresorbable polymer sirolimus-eluting stent had a significantly lower rate of target lesion failure and target vessel-related myocardial infarction than a thin, durable polymer everolimus-eluting stent at 12â¯months, driven by a lower rate of peri-procedural myocardial infarction (ppMI). METHODS: We used a Markov model to project mortality and cost outcomes of that lower ppMI rate from a U.S. health system perspective over a 12-month horizon. Model parameters were derived from BIOFLOW V trial data, a systematic literature review and expert interviews. RESULTS: Use of the bioresorbable polymer sirolimus-eluting stent compared to durable polymer everolimus-eluting stent is associated with net reductions in medical cost of $124 (Interquartile Range (IQR) $97-154) per patient in 2018 US$, of which $115 (IQR $76-124) accrues to the initial admission and $10 (IQR $7-72) to cost of follow-up. The lower rate of ppMI translates into a gain of 0.000017 (IQR 0.000011-0.000022) quality-adjusted life-years (QALY) per patient. CONCLUSIONS: Lower ppMI rates of bioresorbable polymer sirolimus-eluting stent translate into reductions in direct medical cost, while improving patient outcomes. Most of the cost reduction is attributed to the initial admission with moderate savings up to 12â¯months post-discharge.
Asunto(s)
Implantes Absorbibles/economía , Fármacos Cardiovasculares/administración & dosificación , Fármacos Cardiovasculares/economía , Enfermedad de la Arteria Coronaria/economía , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos/economía , Costos de la Atención en Salud , Intervención Coronaria Percutánea/economía , Intervención Coronaria Percutánea/instrumentación , Polímeros/economía , Sirolimus/administración & dosificación , Sirolimus/economía , Fármacos Cardiovasculares/efectos adversos , Ensayos Clínicos como Asunto , Simulación por Computador , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Ahorro de Costo , Análisis Costo-Beneficio , Costos de los Medicamentos , Everolimus/administración & dosificación , Everolimus/economía , Humanos , Cadenas de Markov , Modelos Económicos , Infarto del Miocardio/economía , Infarto del Miocardio/mortalidad , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Diseño de Prótesis , Medición de Riesgo , Factores de Riesgo , Sirolimus/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The Medicare Readmissions Reduction Program penalizes hospitals with higher than expected readmission rates after discharge for congestive heart failure (CHF). This exploratory study analyzed whether categorizing readmissions by event severity might have implications for the program. The authors used the 5% MedPAR (Medicare Provider and Analysis Review) data for 2008 to 2014 and ranked 1820 hospitals based on all readmissions, readmissions for CHF, short-stay CHF readmissions, and readmissions for severe CHF with evidence of cardiogenic shock. Ranking hospitals based on severe CHF readmissions changes their relative rank order significantly compared to counting all readmissions. If confirmed in the full Medicare data, the finding could inform the design of the Readmission Reduction Program.
