title: Cost-effectiveness analysis of the orbital atherectomy system: Two-year follow-up.
abstract: BACKGROUND
  The presence of coronary artery calcification is associated with a significant burden of coronary artery disease along with being a predictor of increased adverse ischemic events. The Diamondback 360® Coronary Orbital Atherectomy System (OAS) is a novel device designed to facilitate treatment of calcified lesions. This study aimed to evaluate the cost-effectiveness of OAS compared to standard treatment.
  
  
  METHODS
  A decision tree model utilizing ORBIT II clinical trial and Medicare data from the health system perspective was constructed. Target population was U.S. patients age≥65 with coronary atherosclerosis due to a calcified coronary lesion, both inpatients and outpatients, and combined over a time horizon of two years for costs and lifetime for mortality. OAS was compared to standard treatment (use of balloon angioplasty to prepare stent-placement site). Outcomes were costs of index event and target vessel revascularization in two years, life-years gained, and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  On average, OAS was projected to cost $1702 less than standard treatment for inpatients, $2360 more than standard treatment for outpatients, and $959 more than standard treatment overall; the projected mortality reduction implies 0.41 life-years gained. Compared to standard treatment, OAS was dominant in an inpatient setting, had an ICER of $5759 per QALY in the outpatient setting, and had an ICER of $2340 per QALY overall. These ICERs are below the accepted threshold for highly cost-effective interventions of $50,000 per QALY.
  
  
  CONCLUSIONS
  Compared to standard treatment, OAS is likely to be cost-effective and was projected to be cost-saving in an inpatient setting.
  
  
  CONCLUSIONS
  A decision tree from the health system perspective was used to evaluate the cost-effectiveness of Diamondback 360® Coronary Orbital Atherectomy System (OAS), a novel device designed to facilitate treatment of calcified lesions. OAS was projected to cost $1702 less than standard treatment for inpatients, $2360 more than standard treatment for outpatients, and $959 more than standard treatment overall; the projected mortality reduction implies 0.41 life-years gained. Compared to standard treatment, OAS was dominant in an inpatient setting, had an ICER of $5759 per QALY in the outpatient setting, and overall had an ICER of $2340 per QALY.
authors.affiliation: University of Washington and VeriTech Corporation, Seattle, WA. Electronic address: lgarrisn@uw.edu.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.affiliation: University of Washington and VeriTech Corporation, Seattle, WA.
authors.forename: Marita R
authors.initials: MR
authors.lastname: Zimmermann
authors.affiliation: The Moran Company, Washington, D.C.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Young
authors.affiliation: JC Consulting Group, Inc., Scituate, MA.
authors.forename: Janna
authors.initials: J
authors.lastname: Crittendon
authors.affiliation: Cardiovascular Research Foundation, New York, NY; Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada; Morristown Medical Center, Morristown, NJ, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000191:economics*; D003324:Coronary Artery Disease / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D012720:Severity of Illness Index; D013997:Time Factors; D061205:Vascular Calcification / Q000191:economics* / Q000628:therapy*
keywords: Calcification; Coronary; Cost-effectiveness; Orbital atherectomy