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Título:	Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial.
Autor/a:	Schur, Nadine; Brugaletta, Salvatore; Cequier Fillat, Àngel R.; Iñiguez Romo, Andres; Serra, Antonio; Jiménez Quevedo, Pilar; Mainar, Vicente; Campo, Gianluca; Tespili, Maurizio; Heijer, Peter den; Bethencourt, Armando; Vazquez, Nicolás; Valgimigli, Marco; Serruys, Patrick W.; Ademi, Zanfina; Schwenkglenks, Matthias; Sabaté Tenas, Manuel
Notas:	BACKGROUND: Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year 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 adopted 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 and publicly available sources. 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. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%. RESULTS: The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was ¿430 more costly than BMS (¿8,305 vs. ¿7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of ¿3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of ¿25,000 per quality-adjusted life-years gained in 86.9% of simulation runs. CONCLUSIONS: Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values.
Materia(s):	-Infart de miocardi -Anàlisi cost-benefici -Terapèutica -Espanya -Myocardial infarction -Cost effectiveness -Therapeutics -Spain
Derechos:	cc-by (c) Schur, Nadine et al., 2018 http://creativecommons.org/licenses/by/3.0/es
Tipo de documento:	Artículo Artículo - Versión publicada
Editor:	Public Library of Science (PLoS)
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