Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

Chivardi, C. et al. (2024) Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial. Circulation: Cardiovascular Quality and Outcomes, 17(1), e010533. (doi: 10.1161/circoutcomes.123.010533) (PMID:37929587) (PMCID:PMC10782932)

Abstract

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom.

• Item Type: Articles
• Additional Information: This trial was sponsored by King’s College London and funded by the National Institute for Health and Care Research Health Technology Assessment Program (10/57/67). The arrhythmia analyses were supported by the British Heart Foun-dation (fellowship FS/CRTF/21/24190 and the King’s British Heart Foundation Center of Research Excellence grant RE/18/2/34213).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Petrie, Professor Mark
• Authors: Chivardi, C., Morgan, H., Sculpher, M. J., Clayton, T., Evans, R., Dodd, M., Petrie, M., Rinaldi, C. A., O'Kane, P., Brown, L., Perera, D., Saramago, P., Perera, D., Chiribiri, A., Carr-White, G., Pavlidis, A., Redwood, S., Clapp, B., Rinaldi, A., Rahman, H., Briceno, N., Arnold, S., Raynsford, A., Wilson, K., Clack, L., Petrie, M., McEntegart, M., Watkins, S., Shaukat, A., Rocchiccioli, P., McAdam, M., McPherson, E., Cowan, L., Wood, M., Weerackody, R., Davies, C., Smith, E., Modi, B., Mathew, B., Mitchelmore, O., Adrego, R., Andiapen, M., O’Kane, P., Din, J., Kennard, S., Orr, S., Purnell, C., Greenwood, J., Blaxill, J., Mozid, A., Anderson, M., Somers, K., Dixon, L., Walsh, S., Spence, M., Glover, P., Brown, C., Amin-Youssef, G., Shah, A., McDonagh, T., Byrne, J., Pareek, N., Breeze, J., Antao, C., De Silva, K., Strange, J., Johnson, T., Nightingale, A., Gallego, L., Medina, C., Gershlick, A., McCann, G., Ladwiniec, A., Squire, I., Davison, J., Kenmuir-Hogg, K., Spratt, J., Cosgrove, C., Williams, R., Firoozi, S., Lim, P., Bonato, G., Sookhoo, V., Conway, D., Brooksby, P., Wright, J., Exley, D., Cotton, J., Horton, R., Metherell, S., Smallwood, A., Hogrefe, K., Cheng, A., Beirnes, C., Sidgwick, S., Lockie, T., Patel, N., Rakhit, R., Davies, N., Smit, A., Ahmed, F., Hendry, C., Fath-Odoubadi, F., Fraser, D., Mamas, M., Oommen, A., Charles, T., Behan, M., Japp, A., Rif, B., Jenkins, N., McClure, S., Oates, P., Martin, K., Abdelaal, E., Sarma, J., Shastri, S., Riley, J., Giannopoulou, S., Quinn, S., Magapu, P., Stables, R., Wright, D., Barton, J., Clarkson, N., Mahmoudi, M., Flett, A., Curzen, N., Radmore, J., Gough, S., Ludman, A., Kurdi, H., Keenan, S., Banerjee, P., Tapp, L., Edwards, N., Gibson, C., Kukreja, N., Lynch, M., Barratt, C., de Belder, M., Thambyrajah, J., Swanson, N., Richardson, C., Atkinson, B., Viswanathan, G., Waugh, D., Routledge, H., Trevelyan, J., Doughty, A., Pegge, N., Dhamrait, S., Moore, S., Galasko, G., Cassidy, C., Waddington, N., Edwards, T., Iqbal, J., Witherow, F., Birch, J., Munro, M., Wells, T., Sinha, M., Frost, L., Lee, K., Beattie, J., Pitt, M., Chung, A., Ramcharitar, S., McCafferty, L., Martin, T., Irving, J., Iskandar, Z., Hutcheon, A., Gunn, J., Al-Mohammad, A., Agyemang, M., Griffiths, H., Kalra, P., Howe, S., Gray, T., Sobolewska, J., Morby, L., Glover, J., Beynon, J., Knight, J., Das, P., Bellamy, C., Harman, E., Pye, M. M., Megarry, S., McGill, Y., and Redfearn, H.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation: Cardiovascular Quality and Outcomes
• Publisher: American Heart Association
• ISSN: 1941-7705
• ISSN (Online): 1941-7713
• Published Online: 06 November 2023
• Copyright Holders: Copyright: © 2023 The Authors
• First Published: First published in Circulation: Cardiovascular Quality and Outcomes 17(1): e010533
• Publisher Policy: Reproduced under a Creative Commons licence