Key result
PCI plus PiCSO shows cost-effectiveness versus PCI alone at ~17,500€/QALY.
Why the study?
Despite PCI being standard for ST-elevated myocardial infarction, mortality and heart failure remain frequent; PiCSO might reduce infarct size, but its cost-effectiveness was unknown.
Is PCI+PiCSO cost-effective compared to PCI alone in patients with ST-elevated myocardial infarction?
Is PCI+PiCSO cost-effective compared to PCI alone in patients with ST-elevated myocardial infarction?
PCI+PiCSO is a cost-effective strategy compared to PCI alone for STEMI patients from the Italian National Healthcare Service perspective.
May support modeled cost-effectiveness of PCI+PiCSO in Italian STEMI; leaves open confirmation in prospective trials.
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.
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Rognoni et al. (2023) studied ST-elevated myocardial infarction undergoing percutaneous coronary intervention. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) + PCI vs. PCI alone was evaluated on Cost-effectiveness (ICUR/ICER) (ICUR 17,530€/QALY).
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