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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.

View larger version (24K): [in a new window]   Figure 1 Cumulative follow-up costs for the paclitaxel and control stent groups for the overall trial population (A) and the subgroup assigned to clinical follow-up alone (B). Mean cost differences at 6, 9, and 12 months are indicated in the boxes.

View larger version (17K): [in a new window]   Figure 2 Cumulative distribution plot of the incremental cost-effectiveness ratio for paclitaxel-eluting stent compared with bare-metal stent based on bootstrap analysis of the primary TAXUS-IV trial results among the overall study population (A) and the subgroup assigned to clinical follow-up alone (B). As indicated by the arrow, 86% of the resulting cost-effectiveness ratios were <$10,000 per target vessel revascularization event avoided for the overall population, and 90% were less than this threshold for the clinical follow-up cohort.

View larger version (24K): [in a new window]   Figure 3 Subgroup analyses of rates of target vessel revascularization (TVR) and 1-year medical care cost differences between the paclitaxel and control stent groups along with the associated cost-effectiveness ratios for paclitaxel-eluting stent (PES) versus bare-metal stent implantation. Dominant indicates those subgroups for which PES implantation was economically dominant (i.e., lower overall costs and better clinical outcomes). LAD = left anterior descending coronary artery.