Guglielmo Gallone1, Patrizio Armeni2, Stefan Verheye3, Pierfrancesco Agostoni4, Leo Timmers5, Gianluca Campo6,7, Alfonso Ielasi8, Fabio Sgura9, Giuseppe Tarantini10,11, Liesbeth Rosseel3, Carlo Zivelonghi4, Geert Leenders5, Pieter Stella5, Matteo Tebaldi6,7, Maurizio Tespili8, Gianpiero D'Amico10,11, Luca Baldetti1, Francesco Ponticelli1, Antonio Colombo7, Francesco Giannini7. 1. Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy. 2. SDA Bocconi School of Management and CERGAS (Centre for Research on Social and Healthcare Management), Bocconi University, Milan, Italy. 3. Cardiovascular Center, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium. 4. Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands. 5. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy. 7. Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy. 8. Division of Cardiology, ASST Bergamo Est, "Bolognini" Hospital, Seriate, Italy. 9. Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy. 10. Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy. 11. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Abstract
AIMS: The coronary sinus Reducer is a percutaneous device proven to improve angina symptoms in refractory angina (RA). We evaluated its potential cost-effectiveness and impact on the healthcare resource use. METHODS AND RESULTS: Angina-related healthcare resource usage and quality-of-life data were collected for 215 consecutive RA patients undergoing Reducer implantation in Belgium, the Netherlands, and Italy. Costs were assessed from each country's healthcare system perspective. Data from the date of RA diagnosis to Reducer implantation [Standard-of-Care (SoC)-period] and from Reducer implantation to follow-up (Reducer-period) were compared: during Reducer-period, a significant reduction in angina-driven hospitalizations, outpatient visits, coronary angiograms, and percutaneous coronary interventions per patient-year was observed, translating into significantly reduced costs per patient-year. To assess cost-effectiveness, costs and utilities of 1-year SoC were compared with those of 1-year Reducer-period. Assumptions on Reducer efficacy duration were further explored with modelled projections. Reducer was associated with higher quality-adjusted life years (QALYs: 0.665 vs. 0.580, P < 0.001) and incremental costs, yielding incremental cost-effectiveness ratios (ICERs) of 53 197, 34 948, 63 146 €/QALY gained in Belgium, the Netherlands, and Italy, respectively. Under both the assumptions of 2 and 3 years Reducer effect duration with a 30%-year efficacy decrease, the device yielded ICERs in the range of 1977-20 796 €/QALY gained. CONCLUSION: In patients with RA, Reducer device decreases healthcare resource use and related costs. In a limited 1-year timeframe, Reducer is consistently cost-effective according to a range of cost-effectiveness thresholds. Under the explored assumptions, the device yields cost-effectiveness ratios suggesting high value from all the considered perspectives. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The coronary sinus Reducer is a percutaneous device proven to improve angina symptoms in refractory angina (RA). We evaluated its potential cost-effectiveness and impact on the healthcare resource use. METHODS AND RESULTS:Angina-related healthcare resource usage and quality-of-life data were collected for 215 consecutive RApatients undergoing Reducer implantation in Belgium, the Netherlands, and Italy. Costs were assessed from each country's healthcare system perspective. Data from the date of RA diagnosis to Reducer implantation [Standard-of-Care (SoC)-period] and from Reducer implantation to follow-up (Reducer-period) were compared: during Reducer-period, a significant reduction in angina-driven hospitalizations, outpatient visits, coronary angiograms, and percutaneous coronary interventions per patient-year was observed, translating into significantly reduced costs per patient-year. To assess cost-effectiveness, costs and utilities of 1-year SoC were compared with those of 1-year Reducer-period. Assumptions on Reducer efficacy duration were further explored with modelled projections. Reducer was associated with higher quality-adjusted life years (QALYs: 0.665 vs. 0.580, P < 0.001) and incremental costs, yielding incremental cost-effectiveness ratios (ICERs) of 53 197, 34 948, 63 146 €/QALY gained in Belgium, the Netherlands, and Italy, respectively. Under both the assumptions of 2 and 3 years Reducer effect duration with a 30%-year efficacy decrease, the device yielded ICERs in the range of 1977-20 796 €/QALY gained. CONCLUSION: In patients with RA, Reducer device decreases healthcare resource use and related costs. In a limited 1-year timeframe, Reducer is consistently cost-effective according to a range of cost-effectiveness thresholds. Under the explored assumptions, the device yields cost-effectiveness ratios suggesting high value from all the considered perspectives. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: M J M Silvis; M Dekker; C Zivelonghi; P Agostoni; P R Stella; P A Doevendans; D P V de Kleijn; J P van Kuijk; G E Leenders; L Timmers Journal: Neth Heart J Date: 2020-12-07 Impact factor: 2.380
Authors: Maayan Konigstein; Francesco Ponticelli; Carlo Zivelonghi; Ilan Merdler; Miri Revivo; Stefan Verheye; Francesco Giannini; Shmuel Banai Journal: Clin Cardiol Date: 2021-02-19 Impact factor: 3.287
Authors: Giovanni M Vescovo; Carlo Zivelonghi; Pierfrancesco Agostoni; Mirthe Dekker; Max Silvis; Geert Leenders; Jan Peter van Kuijk; Leo Timmers; Pieter Stella; Shmuel Banai; Stefan Verheye Journal: Heart Vessels Date: 2021-08-10 Impact factor: 2.037