title: The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach.
abstract: BACKGROUND
  Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360(®) Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective.
  
  
  RESULTS
  In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% (p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895.
  
  
  CONCLUSIONS
  Based on economic modeling, the recently approved coronary OAS device is projected to be highly cost-effective for patients who undergo PCI for severely calcified lesions.
authors.affiliation: Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chambers
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: The Cardiac and Vascular Institute Gainesville, Florida, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Lee
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Lewin
authors.affiliation: The Moran Company, Arlington, VA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Young
authors.affiliation: JC Consulting Group, Inc., Boston, MA, USA.
authors.forename: Janna
authors.initials: J
authors.lastname: Crittendon
authors.affiliation: Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Marita
authors.initials: M
authors.lastname: Mann
authors.affiliation: Department of Pharmacy, University of Washington, 1959 NE Pacific Street, H-375A, Box 357630, Seattle, WA 98195-7630, USA lgarrisn@uw.edu.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D002114:Calcinosis / Q000191:economics / Q000473:pathology / Q000628:therapy; D003324:Coronary Artery Disease / Q000191:economics / Q000473:pathology / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D012720:Severity of Illness Index; D014481:United States
keywords: atherectomy; calcium; cost-effectiveness analysis