Cost Effectiveness of PaclitaxelEluting vs Bare Metal Stents: TAXUSIV

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Cost Effectiveness of Paclitaxel-Eluting vs Bare
Metal Stents TAXUS-IV

• Adapted fromBakhai et al. J Am Coll Cardiol
  200648253-261

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Cost of PES vs BMS
Objectives

• To quantify the net 1-year medical costs and cost
  effectiveness of patients undergoing
  revascularization procedures with
  paclitaxel-eluting (TAXUS, Boston Scientific) or
  bare metal stents as well as the impact of
  angiographic compared to clinical follow-up at 1
  year

Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Study Design

• N 1,314
• Single vessel de novo lesion 10-28 mm in length
• Direct medical costs
• Procedural costs Medications balloons/stents
  other
• Medical costs Initial procedure
  facilities/staff professional fees
• Follow-up costs Hospitalizations outpatient
  services/medications physician fees
• Cost effectiveness
• Incremental cost / repeat revascularization
• Cost / quality adjusted life year

Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Baseline Demographics
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Procedural Resources
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Initial Hospital Events
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Follow-up Events
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Results Medical Costs

11,096
9,067

Plt0.001 paclitaxel vs bare metal
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Results Cost Effectiveness Ratio / TVR Avoided
Dominant
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Results Cost Effectiveness Ratio / QALY Gained
Dominant
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Results Cost Effectiveness Ratio / TVR Avoided
by Subgroup
Dom
Dom
Bakhai et al. J Am Coll Cardiol 200648253-261
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Cost of PES vs BMS
Conclusions

• Significant reductions in target vessel
  revascularization associated with PES
• 2,000 per patient greater hospital cost
  associated with use of PES
• 1,500 per patient reduced follow-up medical
  care cost associated with use of PES
• Cost savings associated with PES in diabetic,
  diameter lt2.5 mm patients

Bakhai et al. J Am Coll Cardiol 200648253-261