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Cost-effectiveness analysis of short-duration dual antiplatelet therapy with newer drug-eluting stent platforms versus longer-duration dual antiplatelet therapy with a second-generation drug-eluting stent in elective percutaneous coronary intervention

Galper, Benjamin Z.a; Reynolds, Matthew R.b,c; Garg, Pallavf; Secemsky, Eric A.d; Valsdottir, Linda R.d; Cohen, David J.e; Yeh, Robert W.c,d

doi: 10.1097/MCA.0000000000000694
PCI
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SDC

Background The cost-effectiveness of newer drug-eluting stents (DES) such as biodegradable-polymer or polymer-free stents with shorter dual antiplatelet therapy (DAPT) duration is unknown. We evaluated the cost-effectiveness of treatment with newer DES that may allow for shorter DAPT duration.

Patients and methods We performed a cost-effectiveness analysis of treatment with newer DES platforms followed by 1 or 3 months of DAPT compared with standard second-generation DES followed by 6 or 12 months of DAPT in patients with stable coronary disease. A Markov model simulated distinct health states over a lifetime. Probabilistic sensitivity analysis and one-way sensitivity analyses were performed. A high-risk bleeding scenario was also evaluated.

Results Among patients with typical bleeding risk, second-generation DES and 6 months of DAPT was less expensive and resulted in marginally higher quality-adjusted life years compared with other strategies. A newer DES platform and 3 months of DAPT was preferred when the risk of fatal bleeding was two times greater than baseline, or when bleeding increased long-term mortality by a factor of 1.5. In a probabilistic sensitivity analysis, second-generation DES and 6 months of DAPT was preferred in 58% of iterations, whereas in a high-risk bleeding patient scenario, a newer DES and 3 months of DAPT was preferred in 52% of iterations.

Conclusion A DES that allows 3 months of DAPT without increasing stent-related events is likely to be cost-effective among patients at elevated risk of bleeding, but not in patients with average bleeding risk.

aDivision of Cardiology, Mid-Atlantic Permanente Medical Group, McLean, Virginia

bLahey Hospital and Medical Center, Burlington

cBaim Institute for Clinical Research

dRichard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

eSaint Luke’s Mid-America Heart Institute, Kansas City, Missouri, USA

fLondon Health Sciences Center, London, Ontario, Canada

Correspondence to Robert W. Yeh, MD, MSc, 375 Longwood Avenue, Boston, MA 02215, USA Tel: +1 617 632 7680; fax: +1 617 632 7698; e-mail: ryeh@bidmc.harvard.edu

Received September 14, 2018

Received in revised form December 5, 2018

Accepted December 8, 2018

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