Understanding the economic impact of intravascular ultrasound (IVUS)

Aims To examine the cost-effectiveness of intravascular ultrasound (IVUS) use during percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in treating coronary artery disease (CAD). Methods and results A Markov model was constructed with a lifetime horizon to compare costs and heal...

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Bibliographic Details
Published in:The European journal of health economics 2016-03, Vol.17 (2), p.185-193
Main Authors: Alberti, Alessandro, Giudice, Pietro, Gelera, Alessandra, Stefanini, Luca, Priest, Virginia, Simmonds, Michael, Lee, Christa, Wasserman, Matthew
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angiography
Angioplasty
Cardiology
Cardiovascular disease
Coronary Disease - economics
Coronary Disease - surgery
Coronary vessels
Cost analysis
Cost efficiency
Cost-Benefit Analysis
Diabetes
Drug-Eluting Stents - economics
Economic impact
Economic models
Economic Policy
Economic statistics
Economic theory
Health care costs
Health Care Costs - statistics & numerical data
Health care expenditures
Health Care Management
Health Economics
Health outcomes
Humans
Implicit costs
Intervention
Italy
Markov Chains
Medical imaging
Medicine
Medicine & Public Health
Middle Aged
Original Paper
Patients
Percutaneous Coronary Intervention - economics
Percutaneous Coronary Intervention - methods
Percutaneous transluminal coronary angioplasty
Pharmacoeconomics and Health Outcomes
Public Finance
Public Health
Quality-Adjusted Life Years
Stents
Studies
Ultrasonic imaging
Ultrasonography
Ultrasonography, Interventional - economics
Utilities costs
Vein & artery diseases
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Summary:Aims To examine the cost-effectiveness of intravascular ultrasound (IVUS) use during percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in treating coronary artery disease (CAD). Methods and results A Markov model was constructed with a lifetime horizon to compare costs and health outcomes between IVUS-guided PCI and PCI guided solely by angiography from an Italian healthcare payer perspective. The population examined included CAD patients undergoing PCI with DES. From a healthcare payer perspective, the resulting incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year was negative in the base-case scenario (i.e., IVUS benefit assumed to persist beyond the first year). When IVUS benefit was assumed to be limited to the first year, the ICER increased to €9,624. This conclusion remained consistent even when scenarios varied regarding the duration of the device's effect. Furthermore, benefits of using IVUS were greater for patients with acute coronary syndrome, renal insufficiency, and diabetes. Conclusions Using IVUS with angiography is a dominant strategy in Italy, and results demonstrate that it is desirable to target those at a greater risk of restenosis (i.e., patients with diabetes, chronic kidney disease, and acute coronary syndrome), who tend to benefit more from accurate stent implantation. Further information is necessary regarding the long-term benefits of IVUS, however sensitivity analysis presented in this research demonstrates a strong argument supporting the cost-effectiveness of IVUS.
ISSN:1618-7598
1618-7601
DOI:10.1007/s10198-015-0670-4