title: Understanding the economic impact of intravascular ultrasound (IVUS).
abstract: OBJECTIVE
  To examine the cost-effectiveness of intravascular ultrasound (IVUS) use during percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in treating coronary artery disease (CAD).
  
  
  RESULTS
  A Markov model was constructed with a lifetime horizon to compare costs and health outcomes between IVUS-guided PCI and PCI guided solely by angiography from an Italian healthcare payer perspective. The population examined included CAD patients undergoing PCI with DES. From a healthcare payer perspective, the resulting incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year was negative in the base-case scenario (i.e., IVUS benefit assumed to persist beyond the first year). When IVUS benefit was assumed to be limited to the first year, the ICER increased to €9,624. This conclusion remained consistent even when scenarios varied regarding the duration of the device's effect. Furthermore, benefits of using IVUS were greater for patients with acute coronary syndrome, renal insufficiency, and diabetes.
  
  
  CONCLUSIONS
  Using IVUS with angiography is a dominant strategy in Italy, and results demonstrate that it is desirable to target those at a greater risk of restenosis (i.e., patients with diabetes, chronic kidney disease, and acute coronary syndrome), who tend to benefit more from accurate stent implantation. Further information is necessary regarding the long-term benefits of IVUS, however sensitivity analysis presented in this research demonstrates a strong argument supporting the cost-effectiveness of IVUS.
authors: Istituto Clinico Sant'Ambrogio, Milan, Italy.
authors: Alessandro
authors: A
authors: Alberti
authors: San Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy.
authors: Pietro
authors: P
authors: Giudice
authors: Boston Scientific, Milan, Italy.
authors: Alessandra
authors: A
authors: Gelera
authors: Boston Scientific, Milan, Italy.
authors: Luca
authors: L
authors: Stefanini
authors: Boston Scientific, Singapore, Singapore.
authors: Virginia
authors: V
authors: Priest
authors: Boston Scientific, Sydney, Australasia.
authors: Michael
authors: M
authors: Simmonds
authors: Double Helix Consulting, London, UK.
authors: Christa
authors: C
authors: Lee
authors: Double Helix Consulting, London, UK. Matthew.wasserman@dhelix.com.
authors: Matthew
authors: M
authors: Wasserman
mesh_terms: D003327:Coronary Disease / Q000191:economics / Q000601:surgery; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008390:Markov Chains; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D018084:Ultrasonography, Interventional / Q000191:economics*
keywords: Angiography; Cost-effectiveness analyses; Drug-eluting stent; Economic evaluations; Intravascular ultrasound; Percutaneous coronary intervention