title: Medical therapy v. PCI in stable coronary artery disease: a cost-effectiveness analysis.
abstract: Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS) reduces angina and repeat procedures compared with optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset their increased costs and small increase in adverse events.
  
  
  
  Cost utility analysis of initial medical therapy v. PCI with either BMS or DES.
  
  
  
  . Markov cohort decision model. Data Sources. Propensity-matched observational data from Ontario, Canada, for baseline event rates. Effectiveness and utility data obtained from the published literature, with costs from the Ontario Case Costing Initiative.
  
  
  
  Patients with stable coronary artery disease, confirmed after angiography, stratified by risk of restenosis based on diabetic status, lesion size, and lesion length. Time Horizon. Lifetime. Perspective. Ontario Ministry of Health and Long Term Care. Interventions. Optimal medical therapy, PCI with BMS or DES.
  
  
  
  Lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).
  
  
  
  of Base Case Analysis. In the overall population, medical therapy had the lowest lifetime costs at $22,952 v. $25,081 and $25,536 for BMS and DES, respectively. Medical therapy had a quality-adjusted life expectancy of 10.1 v. 10.26 QALYs for BMS, producing an ICER of $13,271/QALY. The DES strategy had a quality-adjusted life expectancy of only 10.20 QALYs and was dominated by the BMS strategy. This ranking was consistent in all groups stratified by restenosis risk, except diabetic patients with long lesions in small arteries, in whom DES was cost-effective compared with medical therapy (ICER of $18,826/QALY). Limitations. There is the possibility of residual unobserved confounding.
  
  
  
  In patients with stable coronary artery disease, an initial BMS strategy is cost-effective.
authors.affiliation: Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (HCW, DTK).|Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, ON, Canada (HCW, GT, MDK)|Department of Medicine, University of Toronto, ON, Canada (HCW, GT, DTK, VD, MDK)|Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada (HCW, GT, DTK, MDK)
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, ON, Canada (HCW, GT, MDK)|Department of Medicine, University of Toronto, ON, Canada (HCW, GT, DTK, VD, MDK)|Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada (HCW, GT, DTK, MDK)
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (HCW, DTK).|Department of Medicine, University of Toronto, ON, Canada (HCW, GT, DTK, VD, MDK)|Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada (HCW, GT, DTK, MDK)|Institute for Clinical Evaluative Sciences, ON, Canada (DTK, MDK)
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.affiliation: Department of Medicine, University of Toronto, ON, Canada (HCW, GT, DTK, VD, MDK)|University Health Network–Toronto General Hospital, ON, Canada (VD, MDK)
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, ON, Canada (HCW, GT, MDK)|Department of Medicine, University of Toronto, ON, Canada (HCW, GT, DTK, VD, MDK)|Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada (HCW, GT, DTK, MDK)|Institute for Clinical Evaluative Sciences, ON, Canada (DTK, MDK)|University Health Network–Toronto General Hospital, ON, Canada (VD, MDK)|Faculty of Pharmacy, University of Toronto, ON, Canada (MDK)
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011336:Probability
keywords: Markov models; cost utility analysis; decision analysis; technology assessment