Identifier to cite or link to this item: http://hdl.handle.net/20.500.13003/12010
Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial
Identifiers
ISSN: 1932-6203
WOS ID: 000441850400036
Scopus EID: 2-s2.0-85053560899
PMID: 30114230
Embase PUI: L623904209
Share
Statistics
Item usage statisticsMetadata
Show Dublin Core item recordAuthor
Schur, Nadine; Brugaletta, Salvatore; Cequier, Angel; Iniguez, Andres; Serra, Antonio; Jimenez-Quevedo, Pilar; Mainar, Vicente; Campo, Gianluca; Tespili, Maurizio; den Heijer, Peter; Bethencourt, Armando; Vazquez, Nicolas; Valgimigli, Marco; Serruys, Patrick W.; Ademi, Zanfina; Schwenkglenks, Matthias; Sabate, ManelPublication date
2018-08-16Document type
research articleCitation
Schur N, Brugaletta S, Cequier A, Iniguez A, Serra A, Jimenez-Quevedo P, et al. 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. 2018 Aug 16;13(8):e0201985.Abstract
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.
Publisher version
https://dx.doi.org/10.1371/journal.pone.0201985MeSH
Patient Outcome AssessmentEverolimus
Stents
Proportional Hazards Models
ST Elevation Myocardial Infarction
Follow-Up Studies
Humans
Cost-Benefit Analysis
Drug-Eluting Stents
Health Care Costs
DeCS
Estudios de SeguimientoModelos de Riesgos Proporcionales
Costos de la Atención en Salud
Stents Liberadores de Fármacos
Humanos
Evaluación del Resultado de la Atención al Paciente
Everolimus
Infarto del Miocardio con Elevación del ST
Análisis Costo-Beneficio
Stents