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

Robles-Zurita, J. A., Briggs, A. , Rana, D. , Quayyum, Z., Oldroyd, K. G., Zeymer, U., Desch, S., de Waha-Thiele, S. and Thiele, H. (2020) Economic evaluation of culprit lesion only PCI vs. immediate multivessel PCI in acute myocardial infarction complicated by cardiogenic shock: the CULPRIT-SHOCK trial. European Journal of Health Economics, 21, pp. 1197-1209. (doi: 10.1007/s10198-020-01235-3) (PMID:33029668)

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.

• Item Type: Articles
• Additional Information: CULPRIT-SHOCK is a Collaboration Project funded by the European Union under the 7th Framework Programme under Grant agreement no. 602202 NCT01927549 (ClinicalTrials.gov Identifier).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Rana, Miss Dikshyanta and Quayyum, Dr Zahidul and Robles-Zurita, Dr José and Briggs, Professor Andrew
• Authors: Robles-Zurita, J. A., Briggs, A., Rana, D., Quayyum, Z., Oldroyd, K. G., Zeymer, U., Desch, S., de Waha-Thiele, S., and Thiele, H.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: European Journal of Health Economics
• Publisher: Springer
• ISSN: 1618-7598
• ISSN (Online): 1618-7601
• Published Online: 07 October 2020
• Copyright Holders: Copyright © The Author(s) 2020
• First Published: First published in European Journal of Health Economics 21:1197-1209
• Publisher Policy: Reproduced under a Creative Commons license