title: Economic modeling of new stent platforms to evaluate cost effectiveness: analysis of the TAXUS Liberté versus TAXUS express stents.
abstract: BACKGROUND
  With the changing health care environment, cost effectiveness is an important adjunct to clinical investigation when assessing new medical devices. This study presents an economic model to evaluate cost effectiveness of coronary stents.
  
  
  METHODS
  Markov modeling was developed comparing total costs (Medicare payer perspective) between TAXUS Liberté and TAXUS Express based on 3-year clinical outcomes from the TAXUS ATLAS Small Vessel and Long Lesion trials.
  
  
  RESULTS
  The TAXUS Liberté 2.25-mm stent provided cost savings relative to TAXUS Express from a payer perspective ($17,605 vs. $20,281), driven by reduced target vessel revascularization (0.16 events/patient vs. 0.33 events/patient). In probabilistic sensitivity analyses, TAXUS Liberté was less costly with fewer major adverse cardiac events in over 99% of parameter sets. The TAXUS Liberté Long (38 mm) stent was cost neutral relative to TAXUS Express from a payer perspective ($18,545 vs. $18,551) with fewer myocardial infarctions and cardiac deaths. Accounting for angiography-driven revascularizations, TAXUS Liberté 2.25 mm still provided cost savings relative to TAXUS Express ($16,822 vs. $19,139), although TAXUS Liberté Long was more expensive than TAXUS Express ($17,886 vs. $17,652). From a hospital perspective, TAXUS Liberté Long provided cost savings up to a price premium of $671/stent, driven by fewer stents employed per patient.
  
  
  CONCLUSIONS
  This analysis confirms the utility of economic modeling in assessing new stent platforms. TAXUS Liberté 2.25 mm is economically dominant relative to TAXUS Express when treating small vessels. TAXUS Liberté Long is cost neutral to modestly more costly than TAXUS Express 2.25 mm from a payer perspective.
authors.affiliation: Vascular Therapies, Covidien, Washington, DC, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Turco
authors.forename: Anuraag R
authors.initials: AR
authors.lastname: Kansal
authors.forename: Sean
authors.initials: S
authors.lastname: Stern
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Amorosi
authors.forename: Paul L
authors.initials: PL
authors.lastname: Underwood
authors.forename: Greg D E
authors.initials: GD
authors.lastname: Lissovoy
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D017239:Paclitaxel / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel