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PLOS ONE  2014 

Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

DOI: 10.1371/journal.pone.0098371

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Abstract:

Introduction and Objectives Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.

References

[1]  Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, et al. (2012) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 60: e44–e164 doi:10.1016/j.jacc.2012.07.013.
[2]  Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW (2011) Coronary revascularization trends in the United States, 2001-2008. JAMA J Am Med Assoc 305: 1769–1776 doi:10.1001/jama.2011.551.
[3]  Eisenberg MJ (2006) Drug-eluting stents: the price is not right. Circulation 114: 1745–1754 discussion 1754 doi:10.1161/CIRCULATIONAHA.106.646190.
[4]  Kirtane AJ, Gupta A, Iyengar S, Moses JW, Leon MB, et al. (2009) Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation 119: 3198–3206 doi:10.1161/CIRCULATIONAHA.108.826479.
[5]  Pursnani S, Korley F, Gopaul R, Kanade P, Chandra N, et al. (2012) Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circ Cardiovasc Interv 5: 476–490 doi:10.1161/CIRCINTERVENTIONS.112.970954.
[6]  Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, et al. (2009) Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 373: 1190–1197 doi:10.1016/S0140-6736(09)60552-3.
[7]  Stergiopoulos K, Brown DL (2012) Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med 172: 312–319 doi:10.1001/archinternmed.2011.1484.
[8]  Hlatky MA, Boothroyd DB, Baker L, Kazi DS, Solomon MD, et al. (2013) Comparative effectiveness of multivessel coronary bypass surgery and multivessel percutaneous coronary intervention: a cohort study. Ann Intern Med 158: 727–734 doi:10.7326/0003-4819-158-10-201305210-00639.
[9]  Hill RA, Boland A, Dickson R, Dündar Y, Haycox A, et al.. (2007) Drug-eluting stents: a systematic review and economic evaluation. Health Technol Assess Winch Engl 11: iii, xi–221.
[10]  Weintraub WS, Mahoney EM, Zhang Z, Chu H, Hutton J, et al. (2004) One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial. Heart Br Card Soc 90: 782–788 doi:10.1136/hrt.2003.015057.
[11]  Cohen DJ, Bakhai A, Shi C, Githiora L, Lavelle T, et al. (2004) Cost-effectiveness of sirolimus-eluting stents for treatment of complex coronary stenoses: results from the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) trial. Circulation 110: 508–514 doi:10.1161/01.CIR.0000136821.99814.43.
[12]  Eisenstein EL, Wijns W, Fajadet J, Mauri L, Edwards R, et al. (2009) Long-term clinical and economic analysis of the Endeavor drug-eluting stent versus the Driver bare-metal stent: 4-year results from the ENDEAVOR II trial (Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions). JACC Cardiovasc Interv 2: 1178–1187 doi:10.1016/j.jcin.2009.10.011.
[13]  Hlatky MA, Rogers WJ, Johnstone I, Boothroyd D, Brooks MM, et al. (1997) Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. N Engl J Med 336: 92–99 doi:10.1056/NEJM199701093360203.
[14]  Weintraub WS, Boden WE, Zhang Z, Kolm P, Zhang Z, et al. (2008) Cost-effectiveness of percutaneous coronary intervention in optimally treated stable coronary patients. Circ Cardiovasc Qual Outcomes 1: 12–20 doi:10.1161/CIRCOUTCOMES.108.798462.
[15]  OED website. Available: http://www.oecd.org/std/prices-ppp/ (n.d.).
[16]  Bertoldi EG, Rohde LE, Zimerman LI, Pimentel M, Polanczyk CA (2011) Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: The perspective of a middle-income country's public health system. Int J Cardiol. doi:10.1016/j.ijcard.2011.06.046.
[17]  Kühr EM, Ribeiro RA, Rohde LEP, Polanczyk CA (2011) Cost-effectiveness of supervised exercise therapy in heart failure patients. Value Health J Int Soc Pharmacoeconomics Outcomes Res 14: S100–107 doi:10.1016/j.jval.2011.05.006.
[18]  Antioch KM, Jennings G, Botti M, Chapman R, Wulfsohn V (2002) Integrating cost-effectiveness evidence into clinical practice guidelines in Australia for acute myocardial infarction. Eur J Health Econ HEPAC Health Econ Prev Care 3: 26–39 doi:10.1007/s10198-001-0088-z.
[19]  Villanueva EV, Wasiak J, Petherick ES (2003) Percutaneous transluminal rotational atherectomy for coronary artery disease. Cochrane Database Syst Rev Online: CD003334. doi:10.1002/14651858.CD003334.
[20]  Evers S, Goossens M, de Vet H, van Tulder M, Ament A (2005) Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care 21: 240–245.
[21]  Woods BS, Hawkins N, Scott DA (2010) Network meta-analysis on the log-hazard scale, combining count and hazard ratio statistics accounting for multi-arm trials: a tutorial. BMC Med Res Methodol 10: 54 doi:10.1186/1471-2288-10-54.
[22]  Lu G, Ades AE (2004) Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 23: 3105–3124 doi:10.1002/sim.1875.
[23]  Higgins JP, Whitehead A (1996) Borrowing strength from external trials in a meta-analysis. Stat Med 15: 2733–2749 doi:10.1002/(SICI)1097-0258(19961230)15:24<2?733::AID-SIM562>3.0.CO;2-0.
[24]  Smith TC, Spiegelhalter DJ, Thomas A (1995) Bayesian approaches to random-effects meta-analysis: a comparative study. Stat Med 14: 2685–2699. doi: 10.1002/sim.4780142408
[25]  Lu G, Ades AE, Sutton AJ, Cooper NJ, Briggs AH, et al. (2007) Meta-analysis of mixed treatment comparisons at multiple follow-up times. Stat Med 26: 3681–3699 doi:10.1002/sim.2831.
[26]  Kinlay S (1996) Cost-effectiveness of coronary angioplasty versus medical treatment: the impact of cost-shifting. Aust N Z J Med 26: 20–26. doi: 10.1111/j.1445-5994.1996.tb02902.x
[27]  Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, et al. (2001) Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 344: 1117–1124 doi:10.1056/NEJM200104123441502.
[28]  Legrand VMG, Serruys PW, Unger F, van Hout BA, Vrolix MCM, et al. (2004) Three-year outcome after coronary stenting versus bypass surgery for the treatment of multivessel disease. Circulation 109: 1114–1120 doi:10.1161/01.CIR.0000118504.61212.4B.
[29]  Serruys PW, van Hout B, Bonnier H, Legrand V, Garcia E, et al. (1998) Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II). Lancet 352: 673–681. doi: 10.1016/s0140-6736(97)11128-x
[30]  Weintraub WS, Mauldin PD, Becker E, Kosinski AS, King SB 3rd (1995) A comparison of the costs of and quality of life after coronary angioplasty or coronary surgery for multivessel coronary artery disease. Results from the Emory Angioplasty Versus Surgery Trial (EAST). Circulation 92: 2831–2840. doi: 10.1161/01.cir.92.10.2831
[31]  Meredith I (n.d.) Trial updates & long term follow-up - ENDEAVOR I: 3-year, ENDEAVOR II: 2-year clinical results. May 16-19 2006 Eur Paris 2006.
[32]  Meredith I, Wijns W (n.d.) Clinical Trial Update. ENDEAVOR I & II clinical program: long term follow-up. 4 Sept 2005 ESC Stockh 2005.
[33]  Zeiher A (n.d.) ENDEAVOR clinical Program Update. ENDEAVOR I: 4-year clinical follow-up. ENDEAVOR II: 3-year clinical follow-up. May 22 2007 Eur Barc 2007.
[34]  Rodriguez A, Boullon F, Perez-Bali?o N, Paviotti C, Liprandi MI, et al. (1993) Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI): in-hospital results and 1-year follow-up. ERACI Group. J Am Coll Cardiol 22: 1060–1067. doi: 10.1016/0735-1097(93)90416-x
[35]  Rodriguez A, Mele E, Peyregne E, Bullon F, Perez-Bali?o N, et al. (1996) Three-year follow-up of the Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI). J Am Coll Cardiol 27: 1178–1184. doi: 10.1016/0735-1097(95)00592-7
[36]  Favarato D, Hueb W, Gersh BJ, Soares PR, Cesar LAM, et al. (2003) Relative cost comparison of treatments for coronary artery disease: the First Year Follow-Up of MASS II Study. Circulation 108 Suppl 1II21–23 doi:10.1161/01.cir.0000087381.98299.7b.
[37]  Van Hout BA, Serruys PW, Lemos PA, van den Brand MJBM, van Es G-A, et al. (2005) One year cost effectiveness of sirolimus eluting stents compared with bare metal stents in the treatment of single native de novo coronary lesions: an analysis from the RAVEL trial. Heart Br Card Soc 91: 507–512 doi:10.1136/hrt.2004.034454.
[38]  Sculpher M, Smith D, Clayton T, Henderson R, Buxton M, et al. (2002) Coronary angioplasty versus medical therapy for angina. Health service costs based on the second Randomized Intervention Treatment of Angina (RITA-2) trial. Eur Heart J 23: 1291–1300. doi: 10.1053/euhj.2001.3075
[39]  Cohen DJ, Krumholz HM, Sukin CA, Ho KK, Siegrist RB, et al. (1995) In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty. Results from a randomized clinical trial. Stent Restenosis Study Investigators. Circulation 92: 2480–2487. doi: 10.1161/01.cir.92.9.2480
[40]  Cohen DJ, Lavelle TA, Van Hout B, Li H, Lei Y, et al. (2012) Economic outcomes of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with left main or three-vessel coronary artery disease: one-year results from the SYNTAX trial. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 79: 198–209 doi:10.1002/ccd.23147.
[41]  Bakhai A, Stone GW, Mahoney E, Lavelle TA, Shi C, et al. (2006) Cost effectiveness of paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization: results from the TAXUS-IV Trial. J Am Coll Cardiol 48: 253–261 doi:10.1016/j.jacc.2006.02.063.
[42]  Sch?mig A, Mehilli J, de Waha A, Seyfarth M, Pache J, et al. (2008) A meta-analysis of 17 randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease. J Am Coll Cardiol 52: 894–904 doi:10.1016/j.jacc.2008.05.051.
[43]  Eisenstein EL, Leon MB, Kandzari DE, Mauri L, Edwards R, et al. (2009) Long-term clinical and economic analysis of the Endeavor zotarolimus-eluting stent versus the cypher sirolimus-eluting stent: 3-year results from the ENDEAVOR III trial (Randomized Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Cypher Sirolimus-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions). JACC Cardiovasc Interv 2: 1199–1207 doi:10.1016/j.jcin.2009.10.009.
[44]  Hlatky MA, Boothroyd DB, Melsop KA, Kennedy L, Rihal C, et al. (2009) Economic outcomes of treatment strategies for type 2 diabetes mellitus and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. Circulation 120: 2550–2558 doi:10.1161/CIRCULATIONAHA.109.912709.
[45]  Gudnason T, Gudnadottir GS, Lagerqvist B, Eyjolfsson K, Nilsson T, et al. (2013) Comparison of interventional cardiology in two European countries: a nationwide internet based registry study. Int J Cardiol 168: 1237–1242 doi:10.1016/j.ijcard.2012.11.054.
[46]  Puymirat E, Blanchard D, Perier M-C, Piadonataccio M, Gilard M, et al.. (2013) Study Design and Baseline Characteristics of the National Observational Study of Diagnostic and Interventional Cardiac Catheterization by the French Society of Cardiology. Am J Cardiol. doi:10.1016/j.amjcard.2013.03.030.
[47]  Díaz JF, de La Torre JM, Sabaté M, Goicolea J (2012) Spanish Cardiac Catheterization and Coronary Intervention Registry. 21st official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2011). Rev Esp Cardiol Engl Ed 65: 1106–1116 doi:10.1016/j.recesp.2012.07.021.
[48]  Dehmer GJ, Weaver D, Roe MT, Milford-Beland S, Fitzgerald S, et al. (2012) A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011. J Am Coll Cardiol 60: 2017–2031 doi:10.1016/j.jacc.2012.08.966.
[49]  Reed SD, Anstrom KJ, Bakhai A, Briggs AH, Califf RM, et al. (2005) Conducting economic evaluations alongside multinational clinical trials: toward a research consensus. Am Heart J 149: 434–443 doi:10.1016/j.ahj.2004.11.001.

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