Cost-effectiveness of intravascular ultrasound and optical coherence tomography use for percutaneous coronary intervention procedures

Intracoronary imaging modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve outcomes following percutaneous coronary intervention (PCI) by reducing death, myocardial infarction, and stent failure. This is supported by a recent large-scale meta-analysis. Uptake remains highly variable, however, in part due to concerns over up-front costs. Our objective was to establish the cost-effectiveness of the routine use of both IVUS and OCT in patients undergoing PCI including the most up-to-date clinical data.

Procedural costs of PCI with and without intracoronary imaging were established. Costs were obtained using figures from primary data collection and previously published literature. Outcome measures were established from a contemporary literature review, including a recent large-scale meta-analysis. We developed a Markov model to compare angiography-guided PCI with IVUS- and OCT-guided PCI. The primary outcomes were quality-adjusted life years, discounted costs, and incremental cost-effectiveness ratio (ICER). In the base case, intracoronary imaging is highly cost-effective compared with angiography alone over a lifetime horizon. Both IVUS and OCT conferred a survival benefit of 0.061 quality-adjusted life years. The ICER for IVUS was €6802 ($7361) and for OCT was €8947 ($9682). Results were robust to extensive sensitivity analyses.

Our study suggests that the routine use of intracoronary imaging during PCI is likely to be a cost-effective strategy. Our results may help to inform cardiologists, guideline writers, and financial decision-makers in healthcare sectors regarding the widespread adoption of intracoronary imaging.