The Cost-Effectiveness of Guideline-Driven Use of Drug-Eluting Stents in Victorian Public Hospitals

Thathya Venu Ariyaratne, Zanfina Ademi, Bryan Yan, Molla Huq, Baki Billah, Alexander Black, Gishel New, Nick Andrianopoulos, Christopher M. Reid

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Abstract

Introduction: Clinical decision making in regards to the use of drug-eluting or bare metal stents for percutaneous coronary interventions has been shaped by the identification of criteria for appropriate use. However the cost-implications and effectiveness of adopting these criteria are not clear. Objectives: We aimed to compare the cost-effectiveness of guideline-driven use of DES versus bare-metal stents (BMS), from the perspective of the healthcare provider, in the setting of Victorian public hospitals. Methods: Baseline information and resource utilisation- data were obtained from the Melbourne Interventional Group (MIG) registry for the period of April 2004 to December 2011. Costs of hospitalisations and medication use were derived from published sources. Costs and effectiveness data from the study were combined in a decision analytic modelling framework to determine 12-month cost per repeat-revascularisation avoided, in patients meeting 0, 1, 2, or 3 indications for a DES [diabetes mellitus; small vessels; long lesions; bifurcation lesions; ostial lesions; in-stent restenosis; and/or chronic total occlusions]. Propensity-score-matching was used to account for patient baseline differences in each group. Probabilistic sensitivity analysis (PSA) was undertaken to determine the robustness of results. Results: Refer Table 1 - Expected 12-month cost-effectiveness based on decision analysis (Cost-effectiveness threshold: $50,000 AUD). Conclusion: Guideline-driven use of DES in high-risk patients is cost-saving at 12-months. The value for money attractiveness of DES compared to BMS increased substantially with increasing risk profile (1, 2, or 3-or-more criteria).
Original languageEnglish
Article numberPW241
Number of pages1
JournalGlobal Heart
Volume9
Issue number1S
Publication statusPublished - 2014

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