CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Cost Effectiveness of Paclitaxel-Eluting Stents for Patients Undergoing Percutaneous Coronary Revascularization
Results From the TAXUS-IV Trial
Ameet Bakhai, MD, MRCP*, ,1,
Gregg W. Stone, MD ,3,
Elizabeth Mahoney, ScD*,
Tara A. Lavelle, BA*,
Chunxue Shi, MS*,
Ronna H. Berezin, MPH*,
Betsy J. Lahue, MPH ,2,
Mary Ann Clark, MHA,2,
Michael J. Lacey, MS,2,
Mary E. Russell, MD,2,
Stephen G. Ellis, MD||,3,
James B. Hermiller, MD¶,3,
David A. Cox, MD#,
David J. Cohen, MD, MSc*,**,* on behalf of the TAXUS-IV Investigators
* Harvard Clinical Research Institute, Boston, Massachusetts
Barnet and Chase Farm NHS Trust, Barnet, England
Columbia Presbyterian Hospital, New York, New York
Health Economics and Outcomes Research, Boston Scientific, Natick, Massachusetts
|| Cleveland Clinic Foundation, Cleveland, Ohio
¶ St. Vincent’s Hospital, Indianapolis, Indiana
# Mid Carolina Cardiology, Charlotte, North Carolina
** Division of Cardiology, Beth Israel–Deaconess Medical Center, Boston, Massachusetts.
Manuscript received July 30, 2005;
revised manuscript received February 27, 2006,
accepted February 28, 2006.
* Reprint requests and correspondence: Dr. David J. Cohen, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215. (Email: dcohen{at}caregroup.harvard.edu).
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 per patient with incremental cost-effectiveness ratios of $4,678 per TVR avoided and $47,798/quality-adjusted life year (QALY) gained. Among patients assigned to clinical follow-up alone, the net 1-year cost difference was $97 per patient with cost-effectiveness ratios of $760 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.
|
Abbreviations and Acronyms
| | BMS = bare-metal stent | | CI = confidence interval | | DES = drug-eluting stent | | DRG = diagnosis-related group | | ICU = intensive care unit | | PCI = percutaneous coronary intervention | | PES = paclitaxel-eluting stent | | QALY = quality-adjusted life year | | SES = sirolimus-eluting stent | | TVR = target vessel revascularization |
|
This article has been cited by other articles:
|
|
|
|
 
E. L. Eisenstein, W. Wijns, J. Fajadet, L. Mauri, R. Edwards, P. A. Cowper, D. F. Kong, and K. J. Anstrom
Long-Term Clinical and Economic Analysis of the Endeavor Drug-Eluting Stent Versus the Driver Bare-Metal Stent: 4-Year Results From the ENDEAVOR II Trial (Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions)
J. Am. Coll. Cardiol. Intv.,
December 1, 2009;
2(12):
1178 - 1187.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Garg and M. J. Eisenberg
Drug-Eluting Stents: More Dollars Than Sense?
J. Am. Coll. Cardiol. Intv.,
December 1, 2009;
2(12):
1188 - 1189.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. L. Eisenstein, M. B. Leon, D. E. Kandzari, L. Mauri, R. Edwards, D. F. Kong, P. A. Cowper, K. J. Anstrom, and for the ENDEAVOR III Investigators
Long-Term Clinical and Economic Analysis of the Endeavor Zotarolimus-Eluting Stent Versus the Cypher Sirolimus-Eluting Stent: 3-Year Results From the ENDEAVOR III Trial (Randomized Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Cypher Sirolimus-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions)
J. Am. Coll. Cardiol. Intv.,
December 1, 2009;
2(12):
1199 - 1207.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Ryan, W. Linde-Zwirble, L. Engelhart, L. Cooper, and D. J. Cohen
Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras: Results From the US Medicare Program
Circulation,
February 24, 2009;
119(7):
952 - 961.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Cohen and M. R. Reynolds
Interpreting the results of cost-effectiveness studies.
J. Am. Coll. Cardiol.,
December 16, 2008;
52(25):
2119 - 2126.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A Ostovan, R. Mollazadeh, J. Kojuri, and M. Mirabadi
Experience with Paclitaxel-Eluting Infinnium Coronary Stents
Asian Cardiovasc Thorac Ann,
December 1, 2008;
16(6):
454 - 458.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Kirtane and D. J. Cohen
When Is Better Not Good Enough?: Insights From the COURAGE Economic Study
Circ Cardiovasc Qual Outcomes,
September 1, 2008;
1(1):
4 - 6.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Garg, D. J. Cohen, T. Gaziano, and L. Mauri
Balancing the Risks of Restenosis and Stent Thrombosis in Bare-Metal Versus Drug-Eluting Stents: Results of a Decision Analytic Model
J. Am. Coll. Cardiol.,
May 13, 2008;
51(19):
1844 - 1853.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al.
Highlights of the Year in JACC 2006
J. Am. Coll. Cardiol.,
January 30, 2007;
49(4):
509 - 527.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Ligthart, F. Vlemmix, N. Dendukuri, and J. M. Brophy
The cost-effectiveness of drug-eluting stents: a systematic review
Can. Med. Assoc. J.,
January 16, 2007;
176(2):
199 - 205.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Ryan and D. J. Cohen
Are Drug-Eluting Stents Cost-Effective?: It Depends on Whom You Ask
Circulation,
October 17, 2006;
114(16):
1736 - 1744.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. T. Vaitkus
Common Sense, Dollars and Cents, and Drug-Eluting Stents
J. Am. Coll. Cardiol.,
July 18, 2006;
48(2):
268 - 269.
[Full Text]
[PDF]
|
|
|
|
