Cost-utility Analysis of Different Treatment Modalities in Patients Undergoing Percutaneous Coronary Intervention: Thai PCI Registry

BackgroundCost-utility analyses of percutaneous coronary interventions (PCIs) provide valuable insights into the economic value of these procedures. This analysis aimed to compare the cost-utility of different treatment modalities used for PCI patients within a Thai PCI registry. MethodsClinical and quality-of-life data from 39 hospitals spread throughout Thailand were used in this analysis. Three treatment modalities for PCI procedures were compared: a) radial vs. femoral access, b) partial vs. complete revascularization for multivessel coronary artery disease, and c) use vs. non-use of device-guided PCIs (intracoronary ultrasound, optical coherence tomography or fractional flow reserve). Cost data were obtained from each patients bill for their hospital stay. Utility scores were measured using the Thai EQ-5D-5L at admission, discharge, and one-year post-procedure. The incremental cost-effectiveness ratio (ICER) was then estimated and used for each comparison. ResultsOf 19,701 patients enrolled in 2018-19, approximately one-third (n=7,332) had hospital cost data available for analysis. At discharge, the mean costs associated with radial access and partial revascularization were $986 and $391, respectively, less than the costs for device-guided PCIs, which increased by a mean of $2004. The delta utility gains for these approaches were 2.97, 1.60, and 1.07 at discharge and 1.08, 1.06, and 0.29 at one year, respectively. The estimated ICERs at one year were -$894, -$359, and $7041 per unit of utility gained, respectively. ConclusionRadial access and partial revascularization demonstrated cost-effectiveness, while device-guided PCI incurred high costs for the achieved utility scores. Identifying the factors that influence these outcomes may assist clinicians in tailoring interventions to optimize a patients quality of life after PCI.