Cost effectiveness analysis of drug coated balloon only angioplasty for de novo coronary artery disease intervention

Background DCB angioplasty is an emergent technology for the treatment of coronary artery disease. There is lack of data regarding the cost-effectiveness of DCB-only angioplasty for treatment of de novo coronary artery disease as compared with 2nd DES. We aimed to perform a cost analysis of drug coated balloon (DCB)-only angioplasty versus drug eluting stent (DES), for de novo disease of all vessel sizes and all clinical indications. Methods We compared total costs of patients treated with DCB or DES for first presentation of ST elevation myocardial infarction, non-ST elevation myocardial infarction or stable angina due to de novo disease between 1st January 2018 and 15th November 2019. The health economics analysis was undertaken from the National Health Service perspective, using the national annually published resource, the Personal Social Services Research Unit (PSSRU) and Unit Costs of Health and Social Care 2022. We defined total cost as the sum of 1) procedural devices-cost 2) procedural staff-cost 3) post-PCI hospital stay cost 4) antiplatelet regime cost. A cost minimisation analysis was performed to compare the costs of DCB and DES. Results We present 1952 all-comer, consecutive patients; 902 (1064 lesions) treated with DCB and 1050 (1186 lesions) treated with DES for de novo coronary artery disease. There were very few differences in terms of baseline clinical characteristics. The DCB group had more patients with history of stroke or heart failure while the DES group had more patients with history of smoking or chronic obstructive pulmonary disease. More scoring balloons were used in the DCB group while more intravascular imaging was used in the DES group. The average procedural duration was slightly shortened in the DCB group. The cost per patient was estimated to be £9.02 more expensive in the DCB group (£3153.00 versus £3143.98) (Fig 1). However, the cost per lesion treated was calculated to be £44.29 cheaper in the DCB group (£3007.56 versus £3051.85) (Fig 2). The results were consistent irrespective of duration of long-term antiplatelet medications. Apart from the deterministic analysis, the probabilistic sensitivity analysis showed that in terms of cost per lesion, DCB presents a 92.3% probability of being cost saving. Conclusion We have demonstrated for the first time that DCB-only angioplasty has similar cost to DES per patient and is cost-effective compared to DES in de novo coronary artery disease at the lesion level.