Item request has been placed! ×
Item request cannot be made. ×
loading  Processing Request

Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
اقرأ على الانترنت اقرأ أكثر حفظ في قائمتي
  • معلومة اضافية
    • المصدر:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: San Francisco, CA : Public Library of Science
    • الموضوع:
      Drug-Eluting Stents/*economics ; ST Elevation Myocardial Infarction/*epidemiology ; Stents/*economics; Cost-Benefit Analysis ; Everolimus/administration & dosage ; Follow-Up Studies ; Health Care Costs ; Humans ; Patient Outcome Assessment ; Proportional Hazards Models ; ST Elevation Myocardial Infarction/mortality ; ST Elevation Myocardial Infarction/therapy
    • نبذة مختصرة :
      Competing Interests: The authors have declared that no competing interests exist.
      Background: Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year results of the EXAMINATION trial, from a Spanish health service perspective.
      Methods: Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis adopted a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature and publicly available sources. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%.
      Results: The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was €430 more costly than BMS (€8,305 vs. €7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of €3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of €25,000 per quality-adjusted life-years gained in 86.9% of simulation runs.
      Conclusions: Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values.
    • References:
      Heart. 2012 Apr;98(7):544-51. (PMID: 22313548)
      Lancet. 2016 Jan 23;387(10016):357-366. (PMID: 26520230)
      Cost Eff Resour Alloc. 2003 Dec 19;1(1):8. (PMID: 14687420)
      Spine J. 2018 May 31;:null. (PMID: 29859350)
      Med Decis Making. 2013 Apr;33(3):437-50. (PMID: 23054366)
      J Geriatr Cardiol. 2012 Jun;9(2):108-14. (PMID: 22916055)
      EuroIntervention. 2011 Dec;7(8):977-84. (PMID: 22115622)
      Catheter Cardiovasc Interv. 2017 May;89(6):994-1002. (PMID: 27527508)
      BMJ. 2013 Jun 07;346:f3197. (PMID: 23747967)
      N Engl J Med. 2015 Mar 26;372(13):1213-22. (PMID: 25775087)
      Ann Transl Med. 2016 Jul;4(13):256. (PMID: 27500157)
      Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E375-84. (PMID: 23074085)
      Health Econ. 1999 Jun;8(4):323-33. (PMID: 10398525)
      Gac Sanit. 2010 Mar-Apr;24(2):154-70. (PMID: 19959258)
      J Am Coll Cardiol. 2015 Aug 11;66(6):645-55. (PMID: 26248991)
      EuroIntervention. 2010 Feb;5(7):871-4. (PMID: 20142206)
      Pharmacoeconomics. 2008;26(9):733-44. (PMID: 18767894)
      Eur J Vasc Endovasc Surg. 2018 Jul;56(1):87-93. (PMID: 29622512)
      Circulation. 2007 May 1;115(17):2344-51. (PMID: 17470709)
      PLoS One. 2017 May 12;12(5):e0177476. (PMID: 28498849)
      J Epidemiol Community Health. 2003 Aug;57(8):622-7. (PMID: 12883071)
    • Molecular Sequence:
      ClinicalTrials.gov NCT00828087
    • الرقم المعرف:
      9HW64Q8G6G (Everolimus)
    • الموضوع:
      Date Created: 20180817 Date Completed: 20190131 Latest Revision: 20190131
    • الموضوع:
      20250114
    • الرقم المعرف:
      PMC6095536
    • الرقم المعرف:
      10.1371/journal.pone.0201985
    • الرقم المعرف:
      30114230