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Cost-effectiveness of distal embolic protection for patients undergoing percutaneous intervention of saphenous vein bypass grafts

Results from the SAFER trial

David J. Cohen, MD, MSc^*,,*, Sabina A. Murphy, MSc^*, Donald S. Baim, MD, Tara A. Lavelle, BS^*, Ronna H. Berezin, MPH^*, Donald E. Cutlip, MD^*,, Kalon K.L. Ho, MD, MSc^*,, Richard E. Kuntz, MD, MSc^*, the SAFER Trial Investigators

^* Harvard Clinical Research Institute, Boston, Massachusetts, USA
Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
theDivision of Cardiovascular Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA

View larger version (14K): [in a new window]   Figure 1 Cumulative distribution plot of the incremental cost-effectiveness ratio for embolic protection compared with conventional treatment based on the Saphenous Vein Graft Angioplasty Free of Emboli Randomized trial (SAFER) results. As indicated by the arrow, 97.3% of the bootstrapped cost-effectiveness ratios were <$40,000 per year of life gained.

View larger version (16K): [in a new window]   Figure 2 Impact of variations in the relative risk of death or large myocardial infarction (MI) with the GuardWire versus conventional treatment on the incremental cost-effectiveness ratio for embolic protection. Life expectancy projections for this sensitivity analysis were based on a Markov model of long-term survival contingent on 30-day rates of death or large MI after saphenous vein bypass graft percutaneous coronary intervention (Appendix). The arrow indicates the 95% confidence interval (CI) for the relative risk of death or MI based on the Saphenous Vein Graft Angioplasty Free of Emboli Randomized trial (SAFER) results (0.21 to 0.92).