Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

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  • Kodera Satoshi
    Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
  • Morita Hiroyuki
    Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
  • Kiyosue Arihiro
    Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
  • Ando Jiro
    Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
  • Komuro Issei
    Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo

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<p>Background:The cost-effectiveness of percutaneous coronary intervention (PCI) for ischemic heart disease is undetermined in Japan. The aim of this study was to analyze the cost-effectiveness of PCI compared with medical therapy for ST-elevation myocardial infarction (STEMI) and angina pectoris (AP) in Japan.</p><p>Methods and Results:We used Markov models for STEMI and AP to assess the costs and benefits associated with PCI or medical therapy from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as quality-adjusted life-years (QALY), and ICER <¥5 m per QALY gained was judged to be cost-effective. The impact of PCI on cardiovascular events was based on previous publications. In STEMI patients, the ICER of PCI over medical treatment was ¥0.97 m per QALY gained. The cost-effectiveness probability of PCI was 99.9%. In AP patients, the ICER of fractional flow reserve (FFR)-guided PCI over medical treatment was ¥4.63 m per QALY gained. The cost-effectiveness probability of PCI was 50.4%. The ICER of FFR-guided PCI for asymptomatic patients was ¥23 m per QALY gained.</p><p>Conclusions:In STEMI patients, PCI was cost-effective compared with medical therapy. In AP patients, FFR-guided PCI for symptomatic patients could be cost-effective compared with medical therapy. FFR-guided PCI for asymptomatic patients with myocardial ischemia was not cost-effective.</p>

Journal

  • Circulation Journal

    Circulation Journal 83 (7), 1498-1505, 2019-06-25

    The Japanese Circulation Society

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