Understanding the economic impact of intravascular ultrasound (IVUS).
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.
['Alberti|Alessandro|A|', 'Giudice|Pietro|P|', 'Gelera|Alessandra|A|', 'Stefanini|Luca|L|', 'Priest|Virginia|V|', 'Simmonds|Michael|M|', 'Lee|Christa|C|', 'Wasserman|Matthew|M|']
D003327:Coronary Disease D003362:Cost-Benefit Analysis D054855:Drug-Eluting Stents D017048:Health Care Costs D006801:Humans D007558:Italy D008390:Markov Chains D008875:Middle Aged D062645:Percutaneous Coronary Intervention D019057:Quality-Adjusted Life Years D018084:Ultrasonography, Interventional
Intravascular ultrasound Percutaneous coronary intervention Drug-eluting stent Angiography Cost-effectiveness analyses Economic evaluations