P1396Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction based on the results of the EXAMINATION randomized controlled trial

Abstract

Background: Use of everolimus-eluting stents (EES) has shown to be efficacious and safe in patients with ST-segment elevation myocardial infarction (STEMI) but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. Objective: To assess the cost-effectiveness of EES versus BMS based on the 5-year follow-up results of the EXAMINATION trial, from a Spanish health service perspective. Methods: Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis was based on a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was expressed as cost per QALY gained. Costs and effects were discounted at 3%. Results: The model predicted an average survival time in patients receiving EES and BMS of 10.43 and 10.29 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was €212 more costly than BMS (€42,383 vs. 42,171), but went along with incremental gains of 0.11 QALYs. This resulted in an average ICER over all simulations of €647 per QALY gained and was below a willingness-to-pay threshold of €30,000 per QALY gained in 97.7% of simulation runs. Conclusion: Despite of the higher total costs relative to BMS, EES appeared to be a cost-effective therapy for STEMI patients in Spain due to its incremental effectiveness. Predicted ICERs were below generally accepted threshold values.