Economic evaluation of culprit lesion only PCI vs. immediate multivessel PCI in acute myocardial infarction complicated
- PDF / 710,042 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 30 Downloads / 236 Views
ORIGINAL PAPER
Economic evaluation of culprit lesion only PCI vs. immediate multivessel PCI in acute myocardial infarction complicated by cardiogenic shock: the CULPRIT‑SHOCK trial Jose Antonio Robles‑Zurita1 · Andrew Briggs2 · Dikshyanta Rana1 · Zahidul Quayyum3 · Keith G. Oldroyd4 · Uwe Zeymer5 · Steffen Desch6 · Suzanne de Waha‑Thiele7 · Holger Thiele6 Received: 12 March 2020 / Accepted: 16 September 2020 © The Author(s) 2020
Abstract Background The CULPRIT-SHOCK trial compared two treatment strategies for patients with acute myocardial infarction and multivessel coronary artery disease complicated by cardiogenic shock: (a) culprit vessel only percutaneous coronary intervention (CO-PCI), with additional staged revascularisation if indicated, and (b) immediate multivessel PCI (MV-PCI). Methods A German societal and national health service perspective was considered for three different analyses. The cost utility analysis (CUA) estimated costs and quality adjusted life years (QALYs) based on a pre-trial decision analytic model taking a lifelong time horizon. In addition, a within trial CUA estimated QALYs and costs for 1 year. Finally, the cost effectiveness analysis (CEA) used the composite primary outcome, mortality and renal failure at 30-day follow-up, and the within trial costs. Econometric and survival analysis on the trial data was used for the estimation of the model parameters. Subgroup analysis was performed following an economic protocol. Results The lifelong CUA showed an incremental cost effectiveness ratio (ICER), CO-PCI vs. MV-PCI, of €7010 per QALY and a probability of CO-PCI being the most cost-effective strategy > 64% at a €30,000 threshold. The ICER for the within trial CUA was €14,600 and the incremental cost per case of death/renal failure avoided at 30-day follow-up was €9010. Cost-effectiveness improved with patient age and for those without diabetes. Conclusions The estimates of cost-effectiveness for CO-PCI vs. MV-PCI have been shown to change depending on the time horizon and type of economic evaluation performed. The results favoured a long-term horizon analysis for avoiding underestimation of QALY gains from the CO-PCI arm. Keywords Culprit-shock trial · Economic evaluation · Pre-trial model · Decision analytic modelling JEL Classification I10
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10198-020-01235-3) contains supplementary material, which is available to authorized users. * Jose Antonio Robles‑Zurita JoseAntonio.Robles‑[email protected] 1
2
3
Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK London School of Hygiene & Tropical Medicine, London, UK BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
4
West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
5
Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, G
Data Loading...
