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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2015; 7(10): 594-602
Published online Oct 26, 2015. doi: 10.4330/wjc.v7.i10.594
Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease
Ariel Beresniak, Thibaut Caruba, Brigitte Sabatier, Yves Juillière, Olivier Dubourg, Nicolas Danchin
Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland
Ariel Beresniak, Paris-Descartes University, LIRAES, 75006 Paris, France
Thibaut Caruba, Brigitte Sabatier, Department of Pharmacy, Hôpital Européen Georges Pompidou, 75015 Paris, France
Yves Juillière, Department of Cardiology, Institut Lorrain du Coeur et des Vaisseaux, 54500 Vandœuvre-lès-Nancy, France
Olivier Dubourg, Department of Cardiology, Hôpital Ambroise Paré, 92100 Boulogne, France
Olivier Dubourg, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint Quentin en Yvelines, 78000 Versailles, France
Nicolas Danchin, Division of Coronary Artery Disease and Intensive Cardiac Care, Hôpital Européen Georges Pompidou, 75015 Paris, France
Author contributions: Beresniak A developed the cost-effectiveness model; Caruba T and Sabatier B carried out the literature review and performed the cost study; Juillière Y, Dubourg O and Danchin N contributed to design the structure of the model and validated the model assumptions; all the authors contributed to review the manuscript.
Supported by An unrestrictive grant from Sanofi-Aventis.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ariel Beresniak, MD, MPH, PhD, Data Mining International, Research and Development, Route de l’Aéroport, 29-31, CP221, CH-1215 Geneva, Switzerland. aberesniak@datamining-international.com
Telephone: +41-22-7993400 Fax: +41-22-7883850
Received: January 27, 2015
Peer-review started: January 28, 2015
First decision: February 7, 2015
Revised: September 6, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: October 26, 2015
Processing time: 279 Days and 18.5 Hours
Abstract

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.

Keywords: Cost-effectiveness; Percutaneous coronary; Coronary artery disease; Drug eluting stent

Core tip: The objective of this study is to develop a robust cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Mean cost-effectiveness ratios showed slightly lower costs per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). The sequential strategy including BMS as the first option appears to be less efficacious but more cost-effective compared to the strategy including DES as first option.