Understanding The Economic Impact of Intravascular Ultrasound / 1

Appendices

Appendix A. Supplementary analyses on BMS implantation

Appendix A-1.Extrapolated post-one year probabilities

Appendix A-2.BMS inputs

Appendix A-3. The resulting ICERs per QALY for BMS implantation

Appendix B. Supplementary analyses on paclitaxel-eluting stents

Appendix B-1.Lifetime ICERs using only paclitaxel-eluting stents

Appendices

AppendixA. Supplementary analyses on BMS implantation

Appendix A-1.Extrapolated post-one year probabilitiesa

Endpoint
(Yearly probability) / IVUS arm / Angiography arm / Source
Base-case analysis: Continuation of IVUS benefits beyond the first year
Revascularisation (1) / 1.56% / 2.46% / [1]
Revascularisation (2) / 1.61% / 2.46% / [2]
Scenario analysis: Benefits of IVUS limited to the first year
MI / 0.64% / [3]
Revascularisation / 2.46%

aThe extrapolated probabilities were applied to the all cycles after the first year.

Appendix A-2. BMS inputs

Variable / Mean / Lower value / Upper value / Source
Odds Ratios (OR) for MI and revascularisation
MI ORa / 0.67 / 0.34 / 1.34 / [2]
Revascularisation OR (1)a / 0.62 / 0.46 / 0.84
Revascularisation OR (2)a / 0.64 / 0.43 / 0.96 / [3]
Probabilities
Probability of having MI: year one
(per month)
With IVUS / 1.79% / 1.61% / 1.97% / [1]
With Angiography / 2.60% / 2.34% / 2.86%
Probability of having revascularisation: year one (per month)
With IVUS / 1.09% / 0.98% / 1.20% / [1]
With Angiography / 1.73% / 1.56% / 1.91%
Probability of having MI: post year oneb
With IVUS / 0.43% / 0.20% / 0.57% / [1]
With Angiography / 0.64% / 0.30% / 0.85%
Probability of having revascularisation: post year oneb
With IVUS / 1.56% / 0.91% / 2.89% / [1]
With Angiography / 2.46% / 1.44% / 4.45%
Probability of death after MI / 17.96% / 16.16% / 19.76% / [4]
Probability of death after CABG or PCI / 2.77% / 2.49% / 3.05% / [1]
Probability of MI being treated with revascularisationc,d / 50% / 45% / 55%
Probability of revascularisation being treated with CABGc,d / 10% / 9% / 11%
Discounting rates for costs and outcomes / 3% / 0% / 8% / [5]
Utilities
No adverse events occurred after the procedure / 0.83 / 0.75 / 0.92 / [6]
Treated for MI / 0.68 / 0.61 / 0.75 / [7,8]
Treated for revascularisation with PCI / 0.77 / 0.69 / 0.85 / [6]
Treated for revascularisation with CABG / 0.73 / 0.66 / 0.80 / [9]
Death / 0 / 0 / 0
Costs (€)
IVUS / 650 / 585 / 715
Initial PCI with angiography and IVUS / 7,806 / 7,025 / 8,586
Initial PCI with angiography alone / 7,156 / 6,440 / 7,871
MI treated with medications / 3,586 / 3,227 / 3,944
MI treated with PCI / 10,279 / 9,251 / 11,307
MI treated with CABG / 22,125 / 19,913 / 24,338
Revascularisation treated with PCI / 8,491 / 7,642 / 9,340
Revascularisation treated with CABG / 19,112 / 17,201 / 21,023
Medication to manage post-MI / 511 / 460 / 562 / [10,11]

aP-values of ORs for revascularisation (1), revascularisation (2) and MIwere0.004,0.033 and 0.51, individually.

bThe post-year-one probabilities shown in the Table were based on the assumption that benefits of IVUS would persist throughout the cycles (Appendix A-1).

cOnly two out of the four country-adjusted probabilities were displayed. The others, the probability of MI treated with medications and that of having revascularisation with PCI, were calculated as follows: 100-each of the two variables included in the Table (%).

dThese clinical probabilities were obtained and confirmed through consultations with local clinicians.

Appendix A-3. The resulting ICERs per QALY for BMS implantation

IVUS / Angiography / Incremental
When revascularisation OR from Pariseet al. was employed
Year One
Cost / €9,029 / €9,013 / €17
QALYs / 0.808 / 0.803 / 0.005
Cost per QALY gained / €3,340
Year Three
Cost / €9,371 / €9,542 / (€170)
QALYs / 2.366 / 2.353 / 0.013
Cost per QALY gained / (€12,668)a
Year Five
Cost / €9,693 / €10,037 / (€344)
QALYs / 3.807 / 3.784 / 0.023
Cost per QALY gained / (€14,952)a
Lifetime (base-case)
Cost / €11,967 / €13,471 / (€1,504)
QALYs / 13.189 / 13.041 / 0.148
Cost per QALY gained / (€10,180)a
When revascularisation OR from Lodi-Junqueiraet al. was employed
Year One
Cost / €9,063 / €9,013 / €50
QALYs / 0.808 / 0.803 / 0.005
Cost per QALY gained / €10,231
Year Three
Cost / €9,414 / €9,542 / (€128)
QALYs / 2.366 / 2.353 / 0.013
Cost per QALY gained / (€9,653)a
Year Five
Cost / €9,744 / €10,037 / (€294)
QALYs / 3.807 / 3.784 / 0.023
Cost per QALY gained / (€12,913)a
Lifetime (base-case)
Cost / €12,071 / €13,471 / (€1,400)
QALYs / 13.187 / 13.041 / 0.145
Cost per QALY gained / (€9,629)a

aNegative ICERs imply that IVUS-guided PCI with BMS is a dominant treatment option compared to angiography-guided PCI with BMS at a given time horizon.

Appendix B. Supplementary analyses on paclitaxel-eluting stents

Appendix B-1. Lifetime ICERs using only paclitaxel-eluting stents

IVUS / Angiography / Incremental
General patient population
Cost / €12,490 / €13,592 / (€1,102)
LYs / 15.058 / 14.748 / 0.310
Cost per LYG / (€3,553)a
QALYs / 12.303 / 12.021 / 0.281
Cost per QALY gained / (€3,918)a

aNegative ICERs imply that IVUS-guided PCI with paclitaxel-eluting stents is a dominant treatment strategy compared to angiography-guided PCI with paclitaxel-eluting stents.

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