Cost effectiveness of paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization: results from the TAXUS-IV Trial.
OBJECTIVE
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.
Bakhai
Ameet
A
Harvard Clinical Research Institute, Boston, Massachusetts, USA.
Stone
Gregg W
GW
Mahoney
Elizabeth
E
Lavelle
Tara A
TA
Shi
Chunxue
C
Berezin
Ronna H
RH
Lahue
Betsy J
BJ
Clark
Mary Ann
MA
Lacey
Michael J
MJ
Russell
Mary E
ME
Ellis
Stephen G
SG
Hermiller
James B
JB
Cox
David A
DA
Cohen
David J
DJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003327:Coronary Disease / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment / Q000191:economics; D015607:Stents / Q000191:economics*; D016896:Treatment Outcome; D014481:United States
D002317:Cardiovascular Agents; D017239:Paclitaxel