Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial
| Autor: | Salvatore Brugaletta, Matthias Schwenkglenks, Peter den Heijer, Maurizio Tespili, Andrés Iñiguez, Patrick W. Serruys, Pilar Jiménez-Quevedo, Nicolás Vázquez, Nadine Schur, Gianluca Campo, Vicente Mainar, Angel Cequier, Armando Bethencourt, Marco Valgimigli, Manel Sabaté, Antonio Serra, Zanfina Ademi |
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| Přispěvatelé: | Universitat de Barcelona, Cardiology, University of Zurich, Voskuil, Michiel, Schur, Nadine |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Genetics and Molecular Biology (all)
evaluación del desenlace del paciente Economics Cardiovascular Procedures modelos de riesgos proporcionales Cost effectiveness Cost-Benefit Analysis humanos Myocardial Infarction lcsh:Medicine Social Sciences costos de la atención de salud Cardiovascular Medicine 030204 cardiovascular system & hematology Antiplatelet Therapy estudios de seguimiento Vascular Medicine Biochemistry Geographical locations law.invention 0302 clinical medicine Randomized controlled trial law Medicine and Health Sciences 030212 general & internal medicine Myocardial infarction 610 Medicine & health lcsh:Science health care economics and organizations stents liberadores de fármacos Coronary Artery Bypass Grafting Multidisciplinary Cost–benefit analysis Pharmaceutics Drug-Eluting Stents General Medicine Hematology Health Care Costs Cost-effectiveness analysis Anàlisi cost-benefici Europe Cardiovascular Diseases Cardiology Stents General Agricultural and Biological Sciences Research Article medicine.drug medicine.medical_specialty Coronary Stenting Cost-Effectiveness Analysis Genetics and Molecular Biology Surgical and Invasive Medical Procedures 1100 General Agricultural and Biological Sciences Therapeutics NO 03 medical and health sciences Drug Therapy 1300 General Biochemistry Genetics and Molecular Biology Internal medicine medicine Humans European Union Everolimus Espanya Follow-Up Studies Patient Outcome Assessment Proportional Hazards Models ST Elevation Myocardial Infarction Biochemistry Genetics and Molecular Biology (all) Agricultural and Biological Sciences (all) Blood Coagulation 1000 Multidisciplinary Coagulation Disorders business.industry Proportional hazards model Revascularization lcsh:R Thrombosis 10060 Epidemiology Biostatistics and Prevention Institute (EBPI) medicine.disease Terapèutica Economic Analysis Infart de miocardi Spain General Biochemistry Stent Implantation lcsh:Q People and places business Decision analysis |
| Zdroj: | Schur, Nadine; Brugaletta, Salvatore; Cequier, Angel; Iñiguez, Andrés; Serra, Antonio; Jiménez-Quevedo, Pilar; Mainar, Vicente; Campo, Gianluca; Tespili, Maurizio; den Heijer, Peter; Bethencourt, Armando; Vazquez, Nicolás; Valgimigli, Marco; Serruys, Patrick W; Ademi, Zanfina; Schwenkglenks, Matthias; Sabaté, Manel (2018). Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial. PLoS ONE, 13(8), e0201985. Public Library of Science 10.1371/journal.pone.0201985 Recercat. Dipósit de la Recerca de Catalunya instname PLoS ONE PLoS One (online), 13(8):e0201985. Public Library of Science PLoS ONE, Vol 13, Iss 8, p e0201985 (2018) PLoS One r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante Consejo Superior de Investigaciones Científicas (CSIC) r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Dipòsit Digital de la UB Universidad de Barcelona |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0201985 |
| Popis: | Background Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year results of the EXAMINATION trial, from a Spanish health service perspective. Methods Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis adopted a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature and publicly available sources. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%. Results The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was (sic)430 more costly than BMS ((sic) 8,305 vs. (sic)7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of (sic)3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of (sic)25,000 per quality-adjusted life-years gained in 86.9% of simulation runs. Conclusions Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values. The EXAMINATION trial (NCT00828087) was funded by the Spanish Heart Foundation. SB has received speakers' fees from Abbott Vascular and St Jude Medical. MV has received an honorarium as a public speaker for Terumo, the Medicines Company, Medtronic, Iroko, Merck, Abbott, Ely Lilly, AstraZeneca, Cordis, Carbostent and Implantable Devices, and Bayer. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The other authors declare no competing interests. |
| Databáze: | OpenAIRE |
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