PCI not cost-effective in patients with CAD, heart failure vs. optimal medical therapy
Click Here to Manage Email Alerts
Key takeaways:
- PCI was not cost-effective vs. optimal medical therapy alone in patients with CAD and HF.
- Intervention conferred greater cost with minimal difference in QALYs.
PHILADELPHIA — In patients with CAD and ischemic left ventricular dysfunction, PCI did not add significantly more quality-adjusted life-years and cost significantly more compared with optimal medical therapy alone, a speaker reported.
A post hoc cost-effectiveness analysis of the REVIVED-BCIS2 trial was presented at the American Heart Association Scientific Sessions and simultaneously published in Circulation: Cardiovascular Quality and Outcomes.
Image: Adobe Stock
“The REVIVED-BCIS2 trial concluded that PCI did not reduce the incidence of all-cause death or HF hospitalization in patients with ischemic LV dysfunction,” Holly Morgan, MBBS, clinical research fellow at King’s College London, U.K., told Healio. “However, patients assigned to PCI reported a better initial improvement in quality of life with PCI, and although this difference was not sustained over time, this has led some to conclude that PCI is still a beneficial strategy in this cohort. We therefore wanted to assess the cost-effectiveness of PCI compared to optimal medical therapy alone.”
For the REVIVED-BCIS2 trial, 700 patients with LV ejection fraction 35% or less and extensive CAD eligible for PCI and already on optimal medial therapy for HF were randomly assigned to PCI plus optimal medical therapy or optimal medical therapy alone.
As Healio previously reported, PCI did not improve all-cause death or HF hospitalization in the cohort.
For the present analysis, Morgan and colleagues used patient-reported health outcomes data and EuroQol-5D measures for each patient collected at baseline and over a median follow up of 3.5 years.
With a time horizon of 8 years, the researchers estimated the cost-effectiveness and quality-adjusted life-years gained after PCI in patients with ischemic LV dysfunction using trial case report forms.
Morgan and colleagues reported that, over 8 years of follow-up, patients who underwent PCI has similar average QALYs gained compared with medical therapy alone (4.14 with PCI plus medical therapy vs. 4.16 with medical therapy alone) but PCI conferred higher costs (22,352 pounds vs. 15,569 pounds).
“The biggest takeaways were that although PCI provided very similar health benefits, it came at considerably higher cost. Routine use of PCI for the treatment of ischemic LV dysfunction does not appear to be a justifiable use of health care resources,” Morgan told Healio. “Although I am not surprised by the overall results, I believe this analysis is very impactful as it clearly identifies no incremental QALY benefit with considerable incremental cost, with an observed incremental cost-effectiveness ratio of 111,365 pounds per QALY gained, which does not meet recommended cutoffs for U.K. or U.S. health care systems.”
Reference:
Collapse
Morgan H, et al. QCOR at Scientific Sessions: Rapid fire oral abstract presentations. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
Click Here to Manage Email Alerts