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Understanding the economic impact of intravascular ultrasound (IVUS)

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Abstract

Aims

To examine the cost-effectiveness of intravascular ultrasound (IVUS) use during percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in treating coronary artery disease (CAD).

Methods and results

A Markov model was constructed with a lifetime horizon to compare costs and health outcomes between IVUS-guided PCI and PCI guided solely by angiography from an Italian healthcare payer perspective. The population examined included CAD patients undergoing PCI with DES. From a healthcare payer perspective, the resulting incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year was negative in the base-case scenario (i.e., IVUS benefit assumed to persist beyond the first year). When IVUS benefit was assumed to be limited to the first year, the ICER increased to €9,624. This conclusion remained consistent even when scenarios varied regarding the duration of the device’s effect. Furthermore, benefits of using IVUS were greater for patients with acute coronary syndrome, renal insufficiency, and diabetes.

Conclusions

Using IVUS with angiography is a dominant strategy in Italy, and results demonstrate that it is desirable to target those at a greater risk of restenosis (i.e., patients with diabetes, chronic kidney disease, and acute coronary syndrome), who tend to benefit more from accurate stent implantation. Further information is necessary regarding the long-term benefits of IVUS, however sensitivity analysis presented in this research demonstrates a strong argument supporting the cost-effectiveness of IVUS.

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Conflict of interest

Dr. Alessandro Alberti received consulting fees from Boston Scientific. Dr. Pietro Giudice: none to declare.

Author information

Authors and Affiliations

  1. Istituto Clinico Sant’Ambrogio, Milan, Italy

    Alessandro Alberti

  2. San Giovanni Di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy

    Pietro Giudice

  3. Boston Scientific, Milan, Italy

    Alessandra Gelera & Luca Stefanini

  4. Boston Scientific, Singapore, Singapore

    Virginia Priest

  5. Boston Scientific, Sydney, Australasia

    Michael Simmonds

  6. Double Helix Consulting, London, UK

    Christa Lee & Matthew Wasserman

Authors
  1. Alessandro Alberti
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  2. Pietro Giudice
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  3. Alessandra Gelera
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Correspondence to Matthew Wasserman.

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Alberti, A., Giudice, P., Gelera, A. et al. Understanding the economic impact of intravascular ultrasound (IVUS). Eur J Health Econ 17, 185–193 (2016). https://doi.org/10.1007/s10198-015-0670-4

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  • DOI: https://doi.org/10.1007/s10198-015-0670-4

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