Abstract 17397: Establishing the Cost-Effectiveness of Chronic Total Occlusion Percutaneous Coronary Intervention: A Decision-Analytic Model
Introduction. In the setting of chronic stable angina, successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has been shown to produce significant improvement in angina status with some evidence of survival benefit. However, the economic basis for this procedure has not been established compared to optimal medical treatment (OMT). We developed a Markov model to study the cost-effectiveness of CTO PCI relative to OMT.
Methods. The mean and variance of transition probabilities, utilities, and costs related to CTO PCI and OMT were derived from existing CTO registries, disease-specific literature, and our experience. Implications of the strategies with respect to cost and quality of life were calculated. Model duration was limited to 5 years in order to limit influence of comorbid conditions. Sensitivity analyses were based on the factors noted to influence model outcome.
Results. In the reference case, (mean age 60 years, rate of successful CTO PCI 67.9%, and mean transition probabilities, utilities, and costs as defined by the literature and clinical experience) with 5 year model duration, the strategy of CTO PCI incurred higher costs relative to OMT ($31 512 vs $27 805), but also accumulated greater QALYs (2.38 vs 1.99), yielding a cost-effectiveness ratio of $9505 per QALY. Sensitivity analyses showed the utility of OMT, utility post-successful CTO PCI, and utility post-unsuccessful CTO PCI to be the most influential drivers of outcome. Procedural success held limited influence over model outcome at particular utility threshold values. CTO PCI was more cost-effective with longer model duration and achieved the threshold of $50 000/QALY with model duration of 2 years or greater (see Figure).
Conclusions. CTO PCI is cost-effective in selected populations dependent on the utilities derived post-CTO PCI and with OMT. Utility metrics should be employed in future iterations of appropriateness criteria developed for CTO PCI.
- © 2012 by American Heart Association, Inc.