Background:There is increasing evidence that use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography guidance alone. However, concern regarding the cost-effectiveness of IVUS has limited use of this technology worldwide. In this study, we aimed to evaluate the cost-effectiveness of IVUS-guided PCI compared with angiography-guided PCI in patients undergoing drug-eluting stent implantation.Methods:A decision-analytic Markov model was constructed to compare the cost-effectiveness of IVUS to angiography guidance from the Australian healthcare system perspective. Procedure-related morbidity and mortality were estimated from the literature. Costs were obtained from Australian sources. The population of interest was all-comers undergoing PCI with drug-eluting stent. Outcomes of interest included costs, life-expectancy, and quality-adjusted life years (QALYs) for both treatment groups.Results:In the base case, IVUS guidance was cost-effective compared with angiography guidance alone. With 5% annual discounting, IVUS was associated with increased lifetime costs of Australian dollars (AUD) $823 (USD $597) per person and benefits of 0.04 life years and 0.05 QALYs compared with angiography, yielding an incremental cost-effectiveness ratio of AUD $17 539 (USD $12 730) per QALY gained. Results were robust to sensitivity analyses, with IVUS being cost-effective in 99% of 10 000 Monte Carlo iterations assuming a willingness-to-pay threshold of AUD $50 000 per QALY gained. In a worst-case scenario analysis, IVUS remained the cost-effective option, with an ICER of AUD $36 651 (USD $26 601) per QALY gained. Exploratory subgroup analysis revealed that cost-effectiveness may be greatest among patients with left main and complex coronary lesions.Conclusions:Use of IVUS guidance during PCI is likely to be cost-effective compared with angiography guidance alone among patients undergoing drug-eluting stent implantation.

中文翻译：

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血管内超声与血管造影引导的药物洗脱支架植入术：健康经济学分析

背景：越来越多的证据表明，与单独的血管造影指导相比，在经皮冠状动脉介入治疗 (PCI) 期间使用血管内超声 (IVUS) 指导与改善的临床结果相关。然而，对 IVUS 成本效益的担忧限制了该技术在全球的使用。本研究旨在比较IVUS引导下PCI与血管造影引导下PCI在药物洗脱支架植入术患者中的成本效益。方法：构建决策分析Markov模型比较IVUS的成本效益从澳大利亚医疗保健系统的角度来看血管造影指导。从文献中估计了与手术相关的发病率和死亡率。成本是从澳大利亚来源获得的。感兴趣的人群是所有接受 PCI 和药物洗脱支架的人。感兴趣的结果包括两个治疗组的成本、预期寿命和质量调整生命年 (QALY)。结果：在基本情况下，与单独的血管造影指导相比，IVUS 指导具有成本效益。与血管造影术相比，IVUS 每年折扣为 5%，每人终生成本增加 823 美元（597 美元），收益为 0.04 生命年和 0.05 QALY，增加了 17 539 澳元的成本效益比每增加一个 QALY（12730 美元）。结果对敏感性分析是稳健的，假设每个 QALY 的支付意愿阈值为 50 000 澳元，IVUS 在 10 000 次蒙特卡洛迭代中的 99% 具有成本效益。在最坏情况分析中，IVUS 仍然是具有成本效益的选择，每增加一个 QALY，ICER 为 36 651 澳元（26 601 美元）。探索性亚组分析显示，左主干和复杂冠状动脉病变患者的成本效益可能最大。结论：在接受药物洗脱支架植入术的患者中，与单独的血管造影指导相比，PCI 期间使用 IVUS 指导可能具有成本效益。