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Cost-effectiveness analysis of short-duration dual antiplatelet therapy with newer drug-eluting stent platforms versus longer-duration dual antiplatelet therapy with a second-generation drug-eluting stent in elective percutaneous coronary intervention.
Galper, Benjamin Z; Reynolds, Matthew R; Garg, Pallav; Secemsky, Eric A; Valsdottir, Linda R; Cohen, David J; Yeh, Robert W.
Afiliação
  • Galper BZ; Division of Cardiology, Mid-Atlantic Permanente Medical Group, McLean, Virginia.
  • Reynolds MR; Lahey Hospital and Medical Center, Burlington.
  • Garg P; Baim Institute for Clinical Research.
  • Secemsky EA; London Health Sciences Center, London, Ontario, Canada.
  • Valsdottir LR; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Cohen DJ; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Yeh RW; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA.
Coron Artery Dis ; 30(3): 177-182, 2019 05.
Article em En | MEDLINE | ID: mdl-30676386
BACKGROUND: The cost-effectiveness of newer drug-eluting stents (DES) such as biodegradable-polymer or polymer-free stents with shorter dual antiplatelet therapy (DAPT) duration is unknown. We evaluated the cost-effectiveness of treatment with newer DES that may allow for shorter DAPT duration. PATIENTS AND METHODS: We performed a cost-effectiveness analysis of treatment with newer DES platforms followed by 1 or 3 months of DAPT compared with standard second-generation DES followed by 6 or 12 months of DAPT in patients with stable coronary disease. A Markov model simulated distinct health states over a lifetime. Probabilistic sensitivity analysis and one-way sensitivity analyses were performed. A high-risk bleeding scenario was also evaluated. RESULTS: Among patients with typical bleeding risk, second-generation DES and 6 months of DAPT was less expensive and resulted in marginally higher quality-adjusted life years compared with other strategies. A newer DES platform and 3 months of DAPT was preferred when the risk of fatal bleeding was two times greater than baseline, or when bleeding increased long-term mortality by a factor of 1.5. In a probabilistic sensitivity analysis, second-generation DES and 6 months of DAPT was preferred in 58% of iterations, whereas in a high-risk bleeding patient scenario, a newer DES and 3 months of DAPT was preferred in 52% of iterations. CONCLUSION: A DES that allows 3 months of DAPT without increasing stent-related events is likely to be cost-effective among patients at elevated risk of bleeding, but not in patients with average bleeding risk.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Inibidores da Agregação Plaquetária / Custos de Medicamentos / Custos Hospitalares / Stents Farmacológicos / Intervenção Coronária Percutânea Tipo de estudo: Etiology_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Coron Artery Dis Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Inibidores da Agregação Plaquetária / Custos de Medicamentos / Custos Hospitalares / Stents Farmacológicos / Intervenção Coronária Percutânea Tipo de estudo: Etiology_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Coron Artery Dis Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2019 Tipo de documento: Article