Author + information
- Benjamin Zev Galpera,b,
- Matthew Reynoldsa,b,
- Eric Secemskya,b,
- Pallav Garga,b,
- David Cohena,b and
- Robert Yeha,b
Background: Guidelines recommend 6 months of dual antiplatelet therapy after PCI with drug-eluting stents (DES) in stable coronary disease (CAD). Whether treatment with bioabsorbable polymer (BP) DES followed by a shorter duration of dual antiplatelet therapy is cost-effective is unknown.
Methods: We performed a cost-effectiveness analysis comparing BP-DES followed by either 1 or 3 months of DAPT vs durable polymer (DP)-DES followed by either 6 or 12 months of DAPT in patients with stable CAD undergoing PCI. Expected event rates were estimated based on meta-analysis of published data. Shorter DAPT with BP DES was assumed to result in an increase in non-stent related myocardial infarction (MI) and a decrease in bleeding. We used a Markov model to simulate transitions between distinct health states over a lifetime. Patients suffering bleeding or ischemic events were assigned decrements in quality-adjusted life years (QALYs), and upfront and long-term costs. Probabilistic sensitivity analysis (PSA) as well as one-way sensitivity analyses were performed.
Results: Among patients with typical bleeding risk and assuming no impact of bleeding on long-term mortality, treatment with DP-DES with 6-months of DAPT was less expensive (by ∼$100) and resulted in marginally higher (0.01-0.02) QALYs compared with other strategies. These differences were driven by decreased non-stent related MI with longer DAPT. However, treatment with BP-DES with 3-months of DAPT was the preferred strategy when the risk of fatal bleeding on DAPT was 1.5 times greater than average, or when bleeding was assumed to increase the long-term mortality risk by a factor of 1.8. In PSA, at a threshold of $50,000 per QALY gained, DP-DES with 6 months of DAPT was the preferred strategy in 58% of model iterations, while treatment with BP-DES with 3 months of DAPT, DP-DES with 12-months of DAPT, and BP-DES with 1-month of DAPT were preferred in 28%, 14%, and 1% of model iterations, respectively.
Conclusions: Among patients with stable CAD, treatment with BP-DES followed by 3 months of DAPT is most likely to be cost-effective among patients at elevated risk of bleeding. Projected results are sensitive to assumptions about the long-term impact of bleeding.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Intervention: Drug Eluting Stent & Scaffolds
Abstract Category: 21. Interventional Cardiology: Coronary Intervention: Devices
Presentation Number: 1240-135
- 2017 American College of Cardiology Foundation