Presentation (CTI)

OBJECTIVES: Patients with stage 4-5 chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) are at elevated risk of contrast-associated acute kidney injury (CA-AKI), dialysis, prolonged hospitalisation, and reduced quality of life. This analysis evaluated the cost-effectiveness of intravascular ultrasound (IVUS)-guided ultra-low contrast PCI versus angiography-guided PCI in adult, non-dialysis CKD stage 4-5 patients undergoing clinically indicated PCI in Germany, France, and the United Kingdom.
METHODS: A decision-tree model compared IVUS-guided ultra-low contrast PCI with angiography-guided PCI using usual contrast volumes from country-specific healthcare payer perspectives. Outcomes included CA-AKI, dialysis, costs, and quality-adjusted life-years (QALYs). CA-AKI risks were informed by Sakai et al.; dialysis risk and duration by Optum Clinformatics® real-world data; and utilities by NICE’s contrast-induced AKI economic review. AKI costs used country-specific bed-day costs and 10-day length of stay; dialysis costs used country-specific weekly costs and 3-month duration. Deterministic and probabilistic sensitivity analyses, including 1,000 Monte Carlo simulations, assessed uncertainty.
RESULTS: Based on a modelled cohort of 100 patients, IVUS-guided PCI was estimated to reduce CA-AKI events from 15 to 2 and increase total QALYs from 20.30 to 20.38 across countries. Estimated costs decreased from €140,017 to €95,569 in Germany, €143,504 to €139,134 in France, and £112,727 to £76,230 in the United Kingdom. Estimated savings per CA-AKI avoided were €3,419, €336, and £2,807, respectively. IVUS-guided PCI was dominant, with higher QALYs and lower costs, in deterministic base-case analyses across all countries. Tornado analyses identified CA-AKI risk without IVUS as the key cost-savings driver. PSA and CEAC findings supported the cost-effectiveness of IVUS-guided PCI across countries, with high probability of cost-effectiveness across willingness-to-pay thresholds.
CONCLUSIONS: IVUS-guided ultra-low contrast PCI may be cost-saving and more effective than angiography-guided PCI in advanced CKD patients undergoing PCI in Germany, France, and the United Kingdom.