Health care costs comparable for bioresorbable scaffold, DES at 1 year

Although initial health care costs among patients undergoing PCI were higher with use of a bioresorbable vascular scaffold than with a drug-eluting stent, the difference was not significant at 1 year, according to an economic substudy of data from the ABSORB III trial.

Initial procedural costs with the BVS (Absorb, Abbott Vascular) were about $212 per patient higher than with the with the everolimus-eluting cobalt-chromium stent (Xience, Abbott Vascular; $6,316 vs. $6,103; P= .02). Greater balloon catheter use (2.17 vs. 1.86; P < .001) and higher cost of the BVS vs. EES ($1,743 vs. $1,638; P = .005) were the main drivers behind the increased costs associated with the BVS, according to the researchers.

Insignificant differences

However, index hospitalization costs were similar between the BVS group and the EES group (BVS, $15,035; EES, $14,903; P = .37). Total 1-year health care costs were numerically higher in the BVS group vs. the EES group, but the researchers noted the cost difference was only about $350 per patient and was not statistically significant ($17,848 vs. $17,498; P = .29).

The researchers also conducted a sensitivity analysis on the price difference between the BVS and the EES.

“As expected, the greater the cost difference between Absorb and Xience, the greater the 1-year cost difference between the two groups,” they wrote. “If the acquisition cost of the Absorb scaffold was identical to that for the Xience stent, the 1-year cost difference would be $240.”

The researchers estimated index procedural costs based on average cost per procedure at Saint Luke’s Mid-America Heart Institute and adjusted for observed procedure duration. For base case analysis, the cost of the EES was assumed to be $1,250 per stent and the cost of the BVS was assumed to be $100 more per device based on a survey of five U.S. hospitals conducted in August 2016. Index hospitalization costs were assessed using data from the Medicare Provider and Review database, and follow-up costs and physician fees were assessed using Medicare reimbursements.

Caution needed

Despite these encouraging results, clinicians should remain cautious, according to Michael A. Kutcher, MD, of the Wake Forest School of Medicine in Winston-Salem, North Carolina. In an accompanying editorial, he noted that the calculated assumption in cost difference between the BVS and EES is “optimistic and rather low” and that the price of the devices could vary significantly between institutions.

Moreover, Kutcher highlighted the need for more clinical data on outcomes with the BVS.

“There are some worries to darken the horizon of the Absorb stent that could affect long-term cost-effectiveness. The recently published 3-year follow-up of the ABSORB II study found a higher late stent thrombosis rate and repeat PCI intervention,” he wrote.

“The bigger issue is whether the present or future generations of the Absorb stent could be true ‘workhorse’ stents. There is a price to pay for having limited ordnance on the catheterization laboratory shelf and the decision process of when and where to use a bioresorbable stent.”

Long-term findings will be important, according to Kutcher.

“One must put into perspective that the Absorb stent is a first-generation bioresorbable scaffold that is still significantly evolving and improving,” he wrote. “The theoretical concept is sound. Long-term findings from the ABSORB III and ABSORB IV studies will be crucial.” – by Melissa Foster

Disclosure: The study was funded by a research grant from Abbott Vascular. Several researchers reported receiving speaker honoraria, consulting income and/or research grant support from one or more of the following companies: Abbott Vascular, AstraZeneca, Boston Scientific, Daiichi Sankyo, Edwards Lifesciences, Eli Lilly, Medtronic, Reva Corp. and St. Jude Medical.