Cost effectiveness of paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization: results from the TAXUS-IV Trial.

Abstract

OBJECTIVES:

This study sought to compare aggregate medical care costs for patients undergoing percutaneous coronary intervention with paclitaxel-eluting stents (PES) and bare-metal stents (BMS) and to formally evaluate the incremental cost effectiveness of PES for patients undergoing single-vessel percutaneous coronary intervention.

BACKGROUND:

Although the cost effectiveness of SES has been studied in both clinical trials and decision-analytic models, few data exist on the cost effectiveness of alternative drug-eluting stent (DES) designs. In addition, no clinical trials have specifically examined the cost effectiveness of DES among patients managed without mandatory angiographic follow-up.

METHODS:

We performed a prospective economic evaluation among 1,314 patients undergoing percutaneous coronary revascularization randomized to either PES (N = 662) or BMS (N = 652) in the TAXUS-IV trial. Clinical outcomes, resource use, and costs (from a societal perspective) were assessed prospectively for all patients over a 1-year follow-up period. Cost effectiveness was defined as the incremental cost per target vessel revascularization (TVR) event avoided and was analyzed separately among cohorts assigned to mandatory angiographic follow-up (n = 732) or clinical follow-up alone (n = 582).

RESULTS:

The PES reduced TVR by 12.2 events per 100 patients treated, resulting in a 1-year cost difference of 572 dollars per patient with incremental cost-effectiveness ratios of 4,678 dollars per TVR avoided and 47,798 dollars/quality-adjusted life year (QALY) gained. Among patients assigned to clinical follow-up alone, the net 1-year cost difference was 97 dollars per patient with cost-effectiveness ratios of 760 dollars per TVR event avoided and $5,105/QALY gained.

CONCLUSIONS:

In the TAXUS-IV trial, treatment with PES led to substantial reductions in the need for repeat revascularization while increasing 1-year costs only modestly. The cost-effectiveness ratio for PES in the study population compares reasonably with that for other treatments that reduce coronary restenosis, including alternative drug-eluting stent platforms.

• Authors: Ameet Bakhai, Gregg W Stone, Elizabeth Mahoney, Tara A Lavelle, Chunxue Shi, Ronna H Berezin, Betsy J Lahue, Mary Ann Clark, Michael J Lacey, Mary E Russell, Stephen G Ellis, James B Hermiller, David A Cox, David J Cohen, TAXUS-IV Investigators
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 48 Issue 2 Pg. 253-61 (Jul 18 2006) ISSN: 1558-3597 [Electronic] United States
• PMID: 16843171 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cardiovascular Agents
• Paclitaxel

Topics

• Aged
• Angioplasty, Balloon, Coronary (economics)
• Cardiovascular Agents (administration & dosage)
• Coronary Disease (economics, therapy)
• Cost-Benefit Analysis
• Double-Blind Method
• Female
• Health Care Costs (statistics & numerical data)
• Health Services (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Paclitaxel (administration & dosage)
• Prospective Studies
• Quality-Adjusted Life Years
• Randomized Controlled Trials as Topic
• Retreatment (economics)
• Stents (economics)
• Treatment Outcome
• United States