Economic Outcomes of Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention: 1-Year Results From the ABSORB III Trial

JACC Cardiovasc Interv. 2017 Apr 24;10(8):774-782. doi: 10.1016/j.jcin.2017.01.022.

Abstract

Objectives: The purpose of this study was to evaluate the economic impact of the Absorb bioresorbable vascular scaffold compared with the Xience everolimus-eluting stent in patients undergoing percutaneous coronary intervention.

Background: The ABSORB III trial (Everolimus-Eluting Bioresorbable Scaffolds for Coronary Artery Disease) demonstrated that the Absorb scaffold was noninferior to the Xience stent with respect to target lesion failure at 1 year. Whether health care costs differ between the Absorb scaffold and the Xience stent is unknown.

Methods: We performed a prospective health economic study alongside the ABSORB III trial, in which patients undergoing percutaneous coronary intervention for stable or unstable angina were randomized to receive the Absorb scaffold (n = 1,322) or Xience stent (n = 686). Resource use data were collected through 1 year of follow-up. Costs were assessed using resource-based accounting (for procedures), MedPAR data (for other index hospitalization costs), and Medicare reimbursements (for follow-up costs and physician fees).

Results: Initial procedural costs were higher with the Absorb scaffold than the Xience stent ($6,316 ± 1,892 vs. $6,103 ± 1,895; p = 0.02), driven mainly by greater balloon catheter use and the higher cost of the scaffold in the Absorb group. Nonetheless, index hospitalization costs ($15,035 ± 2,992 for Absorb vs. $14,903 ± 3,449 for Xience; p = 0.37) and total 1-year costs ($17,848 ± 6,110 for Absorb vs. $17,498 ± 7,411 for Xience; p = 0.29) were similar between the 2 groups.

Conclusions: Although initial procedural costs were higher with the Absorb scaffold, there were no differences in total 1-year health care costs between the 2 cohorts. Longer term follow-up is needed to determine whether meaningful cost savings emerge after scaffold resorption. (A Clinical Evaluation of Absorb™ BVS, the Everolimus-Eluting Bioresorbable Vascular Scaffold in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT01751906).

Keywords: bioresorbable vascular scaffold; health care economics.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorbable Implants / economics*
  • Aged
  • Australia
  • Cardiovascular Agents / administration & dosage*
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / economics*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / economics*
  • Coronary Artery Disease / therapy*
  • Drug Costs
  • Drug-Eluting Stents / economics*
  • Everolimus / administration & dosage*
  • Everolimus / adverse effects
  • Everolimus / economics*
  • Female
  • Health Care Costs*
  • Hospital Costs
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Male
  • Medicare / economics
  • Middle Aged
  • Models, Economic
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / economics*
  • Percutaneous Coronary Intervention / instrumentation*
  • Prospective Studies
  • Prosthesis Design
  • Time Factors
  • Treatment Outcome
  • United States

Substances

  • Cardiovascular Agents
  • Everolimus

Associated data

  • ClinicalTrials.gov/NCT01751906