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Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI: Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial

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Author(s)
David HongJin LeeHankil LeeJuhee ChoEliseo GuallarKi Hong ChoiSeung Hun LeeDoosup ShinJong-Young LeeSeung-Jae LeeSang Yeub LeeSang Min KimKyeong Ho YunJae Young ChoChan Joon KimHyo-Suk AhnChang-Wook NamHyuck-Jun YoonYong Hwan ParkWang Soo LeeTaek Kyu ParkJeong Hoon YangSeung-Hyuk ChoiHyeon-Cheol GwonYoung Bin SongJoo-Yong HahnDanbee KangJoo Myung Lee
Keimyung Author(s)
Nam, Chang WookYoon, Hyuck Jun
Department
Dept. of Internal Medicine (내과학)
Journal Title
Circ Cardiovasc Qual Outcomes
Issued Date
2024
Volume
17
Issue
3
Abstract
Background:
Although clinical benefits of intravascular imaging-guided percutaneous coronary intervention (PCI) in patients with complex coronary artery lesions have been observed in previous trials, the cost-effectiveness of this strategy is uncertain.

Methods:
RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance vs Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) was conducted in Korea between May 2018 and May 2021. This prespecified cost-effectiveness substudy was conducted using Markov model that simulated 3 states: (1) post-PCI, (2) spontaneous myocardial infarction, and (3) death. A simulated cohort was derived from the intention-to-treat population, and input parameters were extracted from either the trial data or previous publications. Cost-effectiveness was evaluated using time horizon of 3 years (within trial) and lifetime. The primary outcome was incremental cost-effectiveness ratio (ICER), an indicator of incremental cost on additional quality-adjusted life years (QALYs) gained, in intravascular imaging-guided PCI compared with angiography-guided PCI. The current analysis was performed using the Korean health care sector perspective with reporting the results in US dollar (1200 Korean Won, ₩=1 dollar, $). Willingness to pay threshold was $35 000 per QALY gained.

Results:
A total of 1639 patients were included in the trial. During 3-year follow-up, medical costs ($8661 versus $7236; incremental cost, $1426) and QALY (2.34 versus 2.31; incremental QALY, 0.025) were both higher in intravascular imaging-guided PCI than angiography-guided PCI, resulting incremental cost-effectiveness ratio of $57 040 per QALY gained within trial data. Conversely, lifetime simulation showed total cumulative medical cost was reversed between the 2 groups ($40 455 versus $49 519; incremental cost, -$9063) with consistently higher QALY (8.24 versus 7.89; incremental QALY, 0.910) in intravascular imaging-guided PCI than angiography-guided PCI, resulting in a dominant incremental cost-effectiveness ratio. Consistently, 70% of probabilistic iterations showed cost-effectiveness of intravascular imaging-guided PCI in probabilistic sensitivity analysis.

Conclusions:
The current cost-effectiveness analysis suggests that imaging-guided PCI is more cost-effective than angiography-guided PCI by reducing medical cost and increasing quality-of-life in complex coronary artery lesions in long-term follow-up.
Keimyung Author(s)(Kor)
남창욱
윤혁준
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1941-7705
Source
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010230
DOI
10.1161/CIRCOUTCOMES.123.010230
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45638
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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