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Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial

Author

Listed:
  • Nadine Schur
  • Salvatore Brugaletta
  • Angel Cequier
  • Andrés Iñiguez
  • Antonio Serra
  • Pilar Jiménez-Quevedo
  • Vicente Mainar
  • Gianluca Campo
  • Maurizio Tespili
  • Peter den Heijer
  • Armando Bethencourt
  • Nicolás Vazquez
  • Marco Valgimigli
  • Patrick W Serruys
  • Zanfina Ademi
  • Matthias Schwenkglenks
  • Manel Sabaté

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 €430 more costly than BMS (€8,305 vs. €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 €3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of €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.

Suggested Citation

  • Nadine Schur & Salvatore Brugaletta & Angel Cequier & Andrés Iñiguez & Antonio Serra & Pilar Jiménez-Quevedo & Vicente Mainar & Gianluca Campo & Maurizio Tespili & Peter den Heijer & Armando Bethencou, 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, Public Library of Science, vol. 13(8), pages 1-16, August.
    • Handle: RePEc:plo:pone00:0201985
    DOI: 10.1371/journal.pone.0201985
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    References listed on IDEAS

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    1. Thomas G Poder & Jihane Erraji & Lucien P Coulibaly & Kouamé Koffi, 2017. "Percutaneous coronary intervention with second-generation drug-eluting stent versus bare-metal stent: Systematic review and cost–benefit analysis," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-14, May.
    2. Joanne Lord & Maxwell A. Asante, 1999. "Estimating uncertainty ranges for costs by the bootstrap procedure combined with probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 323-333, June.
    3. McCabe, C & Claxton, K & Culyer, AJ, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," MPRA Paper 26466, University Library of Munich, Germany.
    4. C. Elizabeth McCarron & Eleanor M. Pullenayegum & Lehana Thabane & Ron Goeree & Jean-Eric Tarride, 2013. "The Impact of Using Informative Priors in a Bayesian Cost-Effectiveness Analysis," Medical Decision Making, , vol. 33(3), pages 437-450, April.
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