Economic Evaluations of Imaging Guidance for Percutaneous Coronary Interventions: A Scoping Review
Author(s)
Susan Kayser, PhD1, Amy Bolton, BA2, Schezn Lim, MS3;
1Boston Scientific, Principal Health Economist, Marlborough, MA, USA, 2Tufts University, Boston, MA, USA, 3Boston Scientific, Marlborough, MA, USA
1Boston Scientific, Principal Health Economist, Marlborough, MA, USA, 2Tufts University, Boston, MA, USA, 3Boston Scientific, Marlborough, MA, USA
Presentation Documents
OBJECTIVES: Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has demonstrated clinical benefits when used alongside angiography during percutaneous coronary intervention (PCI). However, upfront costs of these technologies are often cited as a barrier to their use. This review evaluated existing economic evaluations of IVI compared to angiography alone during PCI.
METHODS: This scoping review followed the PRISMA-ScR framework. Searches were conducted in Medline, Embase, International Health Technology Assessment, and the Centre for Reviews and Dissemination from January 2006 to October 2024. Eligible English-language publications included peer-reviewed articles, abstracts, and conference proceedings. Studies were included if they reported full economic evaluations (e.g., cost-effectiveness analyses) or partial economic evaluations (e.g., cost analyses). Monetary values were adjusted for inflation and purchasing power parity to convert to 2023 US dollars.
RESULTS: A total of 25 studies (16 articles and 9 abstracts) met the inclusion criteria. Of these, 18 (72%) were partial economic evaluations and 7 (28%) were full economic evaluations. Partial evaluations were from a US provider perspective, showing a large range in IVI-associated costs from 2.3% to 56.9%, depending on the IVI intervention (IVUS and/or OCT), the patient population, and the comparison group (e.g., angiography alone or non-IVUS and/or OCT). Full economic evaluations (Australia, Bulgaria, China, Italy, Korea (n=2), and the UK) studies consistently demonstrated the cost-effectiveness of IVI over time horizons ranging from 1 year to a lifetime. Four (57%) of the seven studies found IVI was the dominant strategy (i.e., cost savings) over the patient lifetime. Of the remaining 3 studies (43%), incremental cost-effectiveness ratios ranged from US $6,610-$20,818 per quality-adjusted life year. Key drivers of cost-effectiveness included reductions in target lesion revascularization, myocardial infarction, and all-cause mortality.
CONCLUSIONS: Despite higher initial hospital costs, IVI alongside angiography reduces repeat interventions and adverse events leading to long-term cost-effectiveness.
METHODS: This scoping review followed the PRISMA-ScR framework. Searches were conducted in Medline, Embase, International Health Technology Assessment, and the Centre for Reviews and Dissemination from January 2006 to October 2024. Eligible English-language publications included peer-reviewed articles, abstracts, and conference proceedings. Studies were included if they reported full economic evaluations (e.g., cost-effectiveness analyses) or partial economic evaluations (e.g., cost analyses). Monetary values were adjusted for inflation and purchasing power parity to convert to 2023 US dollars.
RESULTS: A total of 25 studies (16 articles and 9 abstracts) met the inclusion criteria. Of these, 18 (72%) were partial economic evaluations and 7 (28%) were full economic evaluations. Partial evaluations were from a US provider perspective, showing a large range in IVI-associated costs from 2.3% to 56.9%, depending on the IVI intervention (IVUS and/or OCT), the patient population, and the comparison group (e.g., angiography alone or non-IVUS and/or OCT). Full economic evaluations (Australia, Bulgaria, China, Italy, Korea (n=2), and the UK) studies consistently demonstrated the cost-effectiveness of IVI over time horizons ranging from 1 year to a lifetime. Four (57%) of the seven studies found IVI was the dominant strategy (i.e., cost savings) over the patient lifetime. Of the remaining 3 studies (43%), incremental cost-effectiveness ratios ranged from US $6,610-$20,818 per quality-adjusted life year. Key drivers of cost-effectiveness included reductions in target lesion revascularization, myocardial infarction, and all-cause mortality.
CONCLUSIONS: Despite higher initial hospital costs, IVI alongside angiography reduces repeat interventions and adverse events leading to long-term cost-effectiveness.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE202
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)