Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio.
JACC Cardiovasc Interv. 2017 Apr 24;10(8):774-782. doi: 10.1016/j.jcin.2017.01.022.
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.
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.
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).
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.
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).
本研究旨在评估经皮冠状动脉介入治疗中，与依维莫司洗脱支架（Xience）相比，Absorb 生物可吸收血管支架的经济影响。
ABSORB III 试验（用于治疗冠状动脉疾病的依维莫司洗脱生物可吸收支架）表明，在 1 年时，Absorb 支架在靶病变失败方面不劣于 Xience 支架。Absorb 支架和 Xience 支架的医疗保健成本是否存在差异尚不清楚。
我们在 ABSORB III 试验中进行了一项前瞻性健康经济学研究，其中稳定或不稳定型心绞痛患者被随机分为 Absorb 支架组（n=1322）和 Xience 支架组（n=686）。通过 1 年的随访收集资源使用数据。使用基于资源的核算（手术过程）、MedPAR 数据（其他指数住院费用）和医疗保险报销（随访费用和医师费用）来评估成本。
与 Xience 支架相比，Absorb 支架的初始程序成本更高（6316 美元±1892 美元比 6103 美元±1895 美元；p=0.02），主要是由于球囊导管使用率更高，以及 Absorb 组支架成本更高。尽管如此，指数住院费用（Absorb 组为 15035 美元±2992 美元，Xience 组为 14903 美元±3449 美元；p=0.37）和 1 年总费用（Absorb 组为 17848 美元±6110 美元，Xience 组为 17498 美元±7411 美元；p=0.29）在两组之间相似。
尽管 Absorb 支架的初始程序成本较高，但两组 1 年总医疗保健成本无差异。需要进行更长时间的随访，以确定在支架吸收后是否会出现有意义的成本节约。（Absorb™BVS 的临床评估，即依维莫司洗脱的生物可吸收血管支架在治疗初发原生冠状动脉病变中的应用；NCT01751906）。
