Cost-effectiveness analysis of pressure-controlled intermittent coronary sinus occlusion in elective percutaneous coronary intervention

ABSTRACT

Objectives

Percutaneous coronary intervention (PCI) represents the standard treatment for ST-elevated myocardial infarction, nevertheless, mortality and heart failures are frequent. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) might reduce infarct size showing better patients’ outcomes. We evaluated the cost-effectiveness of PCI+PiCSO compared to PCI from the National Healthcare Service (NHS) perspective in Italy.

Methods

A Markov model was developed to estimate life years (LYs), quality-adjusted life years (QALYs) and costs. A micro-costing analysis has been performed to inform the cost of PCI+PiCSO procedure. Sensitivity analyses were performed to test the robustness of the model results.

Results

Considering a willingness-to-pay threshold of 50,000€/QALY for the ICUR and a cost for PCI+PiCSO procedure of 14,654€, the innovative strategy may be cost-effective compared to PCI alone from the Italian NHS perspective, showing an ICUR of 17,530€/QALY (ICER 14,631€/LY) over a lifetime horizon; the probabilistic sensitivity analysis showed that PCI+PiCSO is cost-effective in 78.8% of simulations.Considering the above mentioned willingness-to-pay threshold, PCI+PiCSO strategy would be cost-effective over a lifetime horizon considering a cost for PCI+PiCSO procedure lower than 28,160€.

Conclusion

PCI+PiCSO procedure may be considered a cost-effective technology that allows reducing cardiac events, while improving patients’ life expectancy and quality of life.

KEYWORDS:

• Cost-effectiveness
• cost-utility
• STEMI
• Pressure-controlled intermittent coronary sinus occlusion
• percutaneous coronary intervention

Article highlights

• Percutaneous coronary intervention (PCI) represents the standard treatment for ST-elevated myocardial infarction (STEMI). Despite improvements in treatments, mortality and heart failures are still frequent.

• Preliminary data suggest that Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) might reduce the infarct size, leading to a reduction in hospitalizations and mortality.

• We assessed the cost-effectiveness of PCI+PiCSO versus PCI alone for the treatment of patients with STEMI from the National Healthcare Service (NHS) perspective in Italy. The cost for PCI+PiCSO procedure of 14,654€ has been assessed through a micro-costing analysis.

• Considering a willingness-to-pay threshold of 50,000€/QALY, PCI+PiCSO strategy would be cost-effective versus PCI alone, over a lifetime horizon, considering a cost for PCI+PiCSO procedure lower than 28,160€.

• PCI+PiCSO procedure may be considered a valuable technology in the Italian context for the improvement of patients’ life expectancy and quality of life.

Declaration of interest

M Valgimigli reports grants and/or personal fees from Astra Zeneca, Terumo, Alvimedica/CID, Abbott Vascular, Daiichi Sankyo, Bayer, CoreFLOW, Idorsia Pharmaceuticals-Ltd, Universität Basel Department Klinische Forschung, Vifor, Bristol-Myers-Squib SA, Biotronik, Boston Scientific, Miracor, Medtronic, Vesalio, Novartis, Chiesi, PhaseBio. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

P Armeni and F Costa contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by C Rognoni and G Segantin. R Scarsini, M Valgimigli and F Loizzi provided clinical advice and contributed to data collection. The first draft of the manuscript was written by C Rognoni and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Availability of data and material

Data supporting the findings of this study are available within the article.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2249612

Additional information

Funding

This work was funded by MIRACOR MEDICAL SA.