Economic evaluation of culprit lesion only PCI vs. immediate multivessel PCI in acute myocardial infarction complicated by cardiogenic shock: the CULPRIT-SHOCK trial

Jose Antonio Robles-Zurita (), Andrew Briggs, Dikshyanta Rana, Zahidul Quayyum, Keith G. Oldroyd, Uwe Zeymer, Steffen Desch, Suzanne Waha-Thiele and Holger Thiele
Additional contact information
Jose Antonio Robles-Zurita: University of Glasgow
Andrew Briggs: London School of Hygiene & Tropical Medicine
Dikshyanta Rana: University of Glasgow
Zahidul Quayyum: BRAC James P Grant School of Public Health, BRAC University
Keith G. Oldroyd: Golden Jubilee National Hospital
Uwe Zeymer: Klinikum Ludwigshafen and Institut für Herzinfarktforschung
Steffen Desch: University of Leipzig and Leipzig Heart Institute
Suzanne Waha-Thiele: University Heart Center Lübeck, University Hospital Schleswig-Holstein (UKSH)
Holger Thiele: University of Leipzig and Leipzig Heart Institute

The European Journal of Health Economics, 2020, vol. 21, issue 8, No 7, 1197-1209

Abstract: Abstract Background The CULPRIT-SHOCK trial compared two treatment strategies for patients with acute myocardial infarction and multivessel coronary artery disease complicated by cardiogenic shock: (a) culprit vessel only percutaneous coronary intervention (CO-PCI), with additional staged revascularisation if indicated, and (b) immediate multivessel PCI (MV-PCI). Methods A German societal and national health service perspective was considered for three different analyses. The cost utility analysis (CUA) estimated costs and quality adjusted life years (QALYs) based on a pre-trial decision analytic model taking a lifelong time horizon. In addition, a within trial CUA estimated QALYs and costs for 1 year. Finally, the cost effectiveness analysis (CEA) used the composite primary outcome, mortality and renal failure at 30-day follow-up, and the within trial costs. Econometric and survival analysis on the trial data was used for the estimation of the model parameters. Subgroup analysis was performed following an economic protocol. Results The lifelong CUA showed an incremental cost effectiveness ratio (ICER), CO-PCI vs. MV-PCI, of €7010 per QALY and a probability of CO-PCI being the most cost-effective strategy > 64% at a €30,000 threshold. The ICER for the within trial CUA was €14,600 and the incremental cost per case of death/renal failure avoided at 30-day follow-up was €9010. Cost-effectiveness improved with patient age and for those without diabetes. Conclusions The estimates of cost-effectiveness for CO-PCI vs. MV-PCI have been shown to change depending on the time horizon and type of economic evaluation performed. The results favoured a long-term horizon analysis for avoiding underestimation of QALY gains from the CO-PCI arm.

Keywords: Culprit-shock trial; Economic evaluation; Pre-trial model; Decision analytic modelling (search for similar items in EconPapers)
JEL-codes: I10 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1007/s10198-020-01235-3 Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:eujhec:v:21:y:2020:i:8:d:10.1007_s10198-020-01235-3

Ordering information: This journal article can be ordered from
http://www.springer. ... cs/journal/10198/PS2

DOI: 10.1007/s10198-020-01235-3

Access Statistics for this article

The European Journal of Health Economics is currently edited by J.-M.G.v.d. Schulenburg

More articles in The European Journal of Health Economics from Springer, Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ) Contact information at EDIRC.
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().