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Wednesday, 20 October 2004

This presentation is part of: Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment

THE CLINICAL BENEFITS AND COST-EFFECTIVENESS OF A HYPOTHETICAL CATHETER-BASED STRATEGY FOR THE DETECTION AND TREATMENT OF VULNERABLE CORONARY PLAQUES, A DECISION ANALYTIC APPROACH

Johanna L. Bosch, PhD1, Molly T. Beinfeld, MPH2, James E. Muller, MD3, Tom Brady, MD3, and G. Scott Gazelle, MD, MPH, PhD2. (1) Erasmus MC, Epidemiology and Biostatistics & Radiology, Rotterdam, Netherlands, (2) Massachusetts General Hospital, MGH-Institute for Technology Assessment, Boston, MA, (3) Massachusetts General Hospital, Center for Integration of Medicine and Innovative Technology (CIMIT), Boston, MA

Purpose: Currently, stenotic coronary plaques are detected and treated without considering their “vulnerability” to rupture. In this study, we evaluated the potential clinical benefits and cost-effectiveness of a hypothetical catheter-based strategy for the detection and treatment of vulnerable/high-risk plaques in patients with coronary artery disease using decision analysis.

Methods: In a new hypothetical strategy, vulnerable coronary plaques are detected with a catheter-based test and treated with a drug-eluting stent, regardless of degree of stenosis. We developed a Markov-decision model to compare the new strategy with current practice (angioplasty followed by stent placement in stenotic arteries). Monte Carlo simulations were performed from a societal perspective, costs were converted to year 2003 U.S. dollars, and future costs and outcomes were discounted at 3%. Sensitivity analyses were performed to evaluate the effect of assumptions such as the prevalence of plaques and treatment effect.

Results: In 60-year old male patients with coronary stenoses the new strategy would be less expensive and more effective than current practice ($43,103 vs. $44,003 and 10.17 vs. 9.86 quality-adjusted life years, respectively). The benefits of the new strategy were robust in sensitivity analyses (e.g., if the prevalence of vulnerable plaques in this patient group was 50% or more and the sensitivity and specificity of the new test were at least 0.80).

Conclusion: The detection of non-stenotic vulnerable plaques with a catheter-based test followed by their treatment with a drug-eluting stent could be a less expensive and more effective strategy than current practice in patients with coronary artery disease. If applied to 1 million such patients in the US undergoing catheterization, the new strategy could add 310,000 quality-adjusted life years and save $826 million dollars per year.


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See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)