Background
Advanced stent platform iterations should be able to demonstrate safety and efficacy advantages over earlier-generation devices while being cost-effective. We developed an economic model to evaluate cost-effectiveness of stent platform changes. Model validation was performed by evaluating the TAXUS Liberté 2.25-mm drug-eluting stent (DES) vs. TAXUS Express 2.25-mm DES in patients with small vessels (SV, ≥2.2–≤2.5 mm) as studied in the TAXUS ATLAS SV trial.
Results
TAXUS Liberté demonstrated cost savings over 3 years relative to TAXUS Express from a payer perspective ($17,605 vs. $20,281), driven by the reduced rate of target vessel revascularization (TVR, 0.16 vs. 0.33 event/patient). Probabilistic sensitivity analyses, varying clinical parameters across their confidence intervals to create statistically plausible sets, show that TAXUS Liberté is economically dominant (less costly with fewer major adverse cardiac events) in over 99% of these parameter sets. These model results reflect the high procedural cost of revascularization and the highly significant reductions in TVR with TAXUS Liberté vs. TAXUS Express in the TAXUS ATLAS SV trial.
Conclusions
This analysis confirms the utility of economic modeling in assessing the value of medical innovation of new stent platforms. Cost-effectiveness analysis shows that the TAXUS Liberté 2.25-mm stent is economically dominant relative to the TAXUS Express 2.25-mm stent when treating small vessels as driven by a reduction in revascularization.
| TAXUS Liberté 2.25 mm | TAXUS Express 2.25 mm | Events avoided with TAXUS Liberté 2.25 mm | |
|---|---|---|---|
| 3-year health outcomes (average per patient) | |||
| TVR-PCI total | 0.16 | 0.33 | 0.17 |
| TVR-CABG total | 0.01 | 0.02 | 0.01 |
| TLR total | 0.13 | 0.25 | 0.12 |
| MI total | 0.05 | 0.04 | −0.01 |
| CD total | 0.03 | 0.05 | 0.02 |
| MACE total | 0.25 | 0.43 | 0.19 |
| Stent thrombosis | 0.01 | 0.02 | 0.01 |
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