Cost-Effectiveness Analysis of Virtual Stent Versus Coronary Angiography in Guiding Coronary Stent Implantation in China: A Markov Model

OBJECTIVES: While coronary angiography is limited to providing imaging assessment of coronary artery stenosis, it remains the standard technique for guiding percutaneous coronary intervention in patients with coronary artery disease. A new technology based on imaging and computational fluid dynamics modeling, known as virtual stent technology, enables the visual display and predictive assessment of the functional outcomes of stent implantation at narrowed vascular sites before actual stenting procedures. The present study aimed to access the long-term cost-effectiveness of virtual stent compared with coronary angiography in guiding coronary stent implantation in China.

METHODS: We built a discrete-time Markov model for comparing the cost-effectiveness of virtual stent strategy versus coronary angiography strategy. In the model, a complete cycle was run 10 times to reflect a 10-year follow-up time span. Transmission probabilities along the Markov chain were adopted from the published literature. Direct medical costs were considered in the analysis from the payer's perspective. Quality-adjusted life-years (QALYs) was used to calculate the effects. 3% discount rate was used for costs and effects. We calculated incremental cost-effectiveness ratios (ICERs) and performed sensitivity analysis to assess the robustness.

RESULTS: At the end of year 10, the virtual stent strategy gained 41,793 yuan in cost and 8.20 QALYs in effectiveness. In contrast, the use of the coronary angiography strategy gained 39,157 yuan in cost and 8.16 QALYs in effectiveness. The ICERs between the two strategies over 10 years is 72,705.27 yuan/QALYs, which was below willingness-to-pay levels of China's once GDP per capita (<85,698 yuan in 2023), indicating that virtual stent strategy is cost-effective. The results remained robust in one-way and probabilistic sensitivity analyses.

CONCLUSIONS: This cost-effectiveness analysis indicates that virtual stent strategy has a relative superiority compared to coronary angiography surgery, suggesting that virtual stent technology should be considered when guiding coronary stent implantation.