title: Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents: Results from a patient level meta-analysis of randomized trials.
abstract: BACKGROUND
  Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI).
  
  
  OBJECTIVE
  To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI.
  
  
  METHODS
  A Markov state transition model with a 2-year time horizon was applied from a US Medicare setting with patients undergoing PCI with Co-Cr EES or BMS. Baseline characteristics, treatment effects, and safety measures were taken from a patient level meta-analysis of 5 RCTs (n = 4,896). The base-case analysis evaluated stent-related outcomes; a secondary analysis considered the broader set of outcomes reported in the meta-analysis.
  
  
  RESULTS
  The base-case and secondary analyses reported an additional 0.018 and 0.013 quality-adjusted life years (QALYs) and cost savings of $236 and $288, respectively with Co-Cr EES versus BMS. Results were robust to sensitivity analyses and were most sensitive to the price of clopidogrel. In the probabilistic sensitivity analysis, Co-Cr EES was associated with a greater than 99% chance of being cost saving or cost effective (at a cost per QALY threshold of $50,000) versus BMS.
  
  
  CONCLUSIONS
  Using data from a recent patient level meta-analysis and contemporary cost data, this analysis found that PCI with Co-Cr EES is more effective and less costly than PCI with BMS. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
authors.affiliation: Health Economics and Reimbursement, Cornerstone Research Group Inc, Burlington, ON, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ferko
authors.affiliation: Interventional Cardiology, Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.affiliation: Health Economics and Outcomes Research Department, Abbott Vascular, Santa Clara, CA.
authors.forename: James T
authors.initials: JT
authors.lastname: Hasegawa
authors.affiliation: Health Economics and Outcomes Research Department, Abbott Vascular, Santa Clara, CA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Schikorr
authors.affiliation: Health Economics and Reimbursement, Cornerstone Research Group Inc, Burlington, ON, Canada.
authors.forename: Ireena M
authors.initials: IM
authors.lastname: Soleas
authors.affiliation: Health Economics and Outcomes Research Department, Abbott Vascular and Abbott Electrophysiology, Santa Clara, CA.
authors.forename: John B
authors.initials: JB
authors.lastname: Hernandez
authors.affiliation: Cardiology Department, University Hospital Clinic, IDIBAPS, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.affiliation: Department of Cardiology, University Hospital of Basel, Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.affiliation: Cardiology Department, University Hospital Clinic, IDIBAPS, Barcelona, Spain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Interventional Cardiology Department, Hospital Marqués De Valdecilla, Santander, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.affiliation: Department of Cardiology, Gentofte Hospital, Hellerup, Denmark.
authors.forename: Soeren
authors.initials: S
authors.lastname: Galatius
authors.affiliation: Heart Institute, University Hospital of Bellvitge, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Franz
authors.initials: F
authors.lastname: Eberli
authors.affiliation: Department of Cardiology, Brighton and Sussex University Hospitals, Brighton, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: Sussex Cardiac Centre, Thoraxcenter, Erasmus Medical Center, CE Rotterdam, Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Cardiology, University Hospital of Bern, Inselspital, Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D002858:Chromium Alloys / Q000191:economics*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics*; D000068338:Everolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D011474:Prosthesis Design; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D002317:Cardiovascular Agents; D002858:Chromium Alloys; D000068338:Everolimus
keywords: bare metal stent; cost-effectiveness; drug-eluting stent; percutaneous coronary intervention