Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction : An analysis from the EXAMINATION randomized controlled trial
Schur, Nadine (University of Basel)
Brugaletta, Salvatore (Hospital Clínic i Provincial de Barcelona)
Cequier, Angel (Hospital Universitari de Bellvitge)
Iñiguez, Andrés (Hospital do Meixoeiro)
Serra, Antoni (Institut d'Investigació Biomèdica Sant Pau)
Jiménez-Quevedo, Pilar (Hospital Universitari San Carlos)
Mainar, Vicente (Hospital General Universitario de Alicante (Alacant, País Valencià))
Campo, Gianluca (Azienda Ospedaliera Universitaria di Ferrara (Cona, Itàlia))
Tespili, Maurizio (University Hospital Bolognini Seriate)
Heijer, Peter den (Amphia Ziekenhuis)
Bethencourt, Armando (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Vazquez, Nicolás (Hospital Juan Canalejo)
Valgimigli, Marco (University Hospital of Bern)
Serruys, Patrick W. (Imperial College London)
Ademi, Zanfina (University of Basel)
Schwenkglenks, Matthias (University of Basel)
Sabaté, Manel (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2018
Resum:	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. 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%. 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 13 Núm. 8 (august 2018) , p. e0201985, ISSN 1932-6203

DOI: 10.1371/journal.pone.0201985
PMID: 30114230

16 p, 2.3 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats