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Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI: Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial.
Hong, David; Lee, Jin; Lee, Hankil; Cho, Juhee; Guallar, Eliseo; Choi, Ki Hong; Lee, Seung Hun; Shin, Doosup; Lee, Jong-Young; Lee, Seung-Jae; Lee, Sang Yeub; Kim, Sang Min; Yun, Kyeong Ho; Cho, Jae Young; Kim, Chan Joon; Ahn, Hyo-Suk; Nam, Chang-Wook; Yoon, Hyuck-Jun; Park, Yong Hwan; Lee, Wang Soo; Park, Taek Kyu; Yang, Jeong Hoon; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol; Song, Young Bin; Hahn, Joo-Yong; Kang, Danbee; Lee, Joo Myung.
Afiliação
  • Hong D; Samsung 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.).
  • Lee J; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.).
  • Lee H; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.).
  • Cho J; College of Pharmacy, Ajou University, Suwon, South Korea (H.L.).
  • Guallar E; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.).
  • Choi KH; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.).
  • Lee SH; Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (E.G.).
  • Shin D; Samsung 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.).
  • Lee JY; Chonnam National University Hospital, Gwangju, Korea (S.H.L.).
  • Lee SJ; Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC (D.S.).
  • Lee SY; Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.).
  • Kim SM; Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.).
  • Yun KH; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.).
  • Cho JY; Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Korea (S.Y.L.).
  • Kim CJ; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.).
  • Ahn HS; Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.).
  • Nam CW; Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.).
  • Yoon HJ; The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.).
  • Park YH; The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.).
  • Lee WS; Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.).
  • Park TK; Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.).
  • Yang JH; Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Korea (Y.H.P.).
  • Choi SH; Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.).
  • Gwon HC; Samsung 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.).
  • Song YB; Samsung 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.).
  • Hahn JY; Samsung 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.).
  • Kang D; Samsung 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.).
  • Lee JM; Samsung 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.).
Circ Cardiovasc Qual Outcomes ; 17(3): e010230, 2024 03.
Article em En | MEDLINE | ID: mdl-38477162
ABSTRACT

BACKGROUND:

Although clinical benefits of intravascular imaging-guided percutaneous coronary intervention (PCI) in patients with complex coronary artery lesions have been observed in previous trials, the cost-effectiveness of this strategy is uncertain.

METHODS:

RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance vs Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) was conducted in Korea between May 2018 and May 2021. This prespecified cost-effectiveness substudy was conducted using Markov model that simulated 3 states (1) post-PCI, (2) spontaneous myocardial infarction, and (3) death. A simulated cohort was derived from the intention-to-treat population, and input parameters were extracted from either the trial data or previous publications. Cost-effectiveness was evaluated using time horizon of 3 years (within trial) and lifetime. The primary outcome was incremental cost-effectiveness ratio (ICER), an indicator of incremental cost on additional quality-adjusted life years (QALYs) gained, in intravascular imaging-guided PCI compared with angiography-guided PCI. The current analysis was performed using the Korean health care sector perspective with reporting the results in US dollar (1200 Korean Won, ₩=1 dollar, $). Willingness to pay threshold was $35 000 per QALY gained.

RESULTS:

A total of 1639 patients were included in the trial. During 3-year follow-up, medical costs ($8661 versus $7236; incremental cost, $1426) and QALY (2.34 versus 2.31; incremental QALY, 0.025) were both higher in intravascular imaging-guided PCI than angiography-guided PCI, resulting incremental cost-effectiveness ratio of $57 040 per QALY gained within trial data. Conversely, lifetime simulation showed total cumulative medical cost was reversed between the 2 groups ($40 455 versus $49 519; incremental cost, -$9063) with consistently higher QALY (8.24 versus 7.89; incremental QALY, 0.910) in intravascular imaging-guided PCI than angiography-guided PCI, resulting in a dominant incremental cost-effectiveness ratio. Consistently, 70% of probabilistic iterations showed cost-effectiveness of intravascular imaging-guided PCI in probabilistic sensitivity analysis.

CONCLUSIONS:

The current cost-effectiveness analysis suggests that imaging-guided PCI is more cost-effective than angiography-guided PCI by reducing medical cost and increasing quality-of-life in complex coronary artery lesions in long-term follow-up. REGISTRATION URL https//www.clinicaltrials.gov; Unique identifier NCT03381872.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Intervenção Coronária Percutânea / Análise de Custo-Efetividade Limite: Humans Idioma: En Revista: Circ Cardiovasc Qual Outcomes Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Intervenção Coronária Percutânea / Análise de Custo-Efetividade Limite: Humans Idioma: En Revista: Circ Cardiovasc Qual Outcomes Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos