Open Heart (May 2024)

Cost-effectiveness of stepwise provisional versus systematic dual stenting strategies in patients with distal bifurcation left main stem lesions: economic analysis of the EBC MAIN trial

  • Isabelle Durand-Zaleski,
  • Mohaned Egred,
  • Adrian P Banning,
  • David Hildick-Smith,
  • Marie-Claude Morice,
  • Philippe Brunel,
  • Alicia Le Bras,
  • Arnaud Nze Ossima,
  • Olivier Supplisson

DOI
https://doi.org/10.1136/openhrt-2023-002479
Journal volume & issue
Vol. 11, no. 1

Abstract

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Background In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting.Aims To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies.Methods Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the healthcare provider with a time horizon of 1 year.Results The cost difference between the two groups was €−755 (€5700 in the stepwise provisional group and €6455 in the systematic dual stenting group, p value<0.01) in France and €−647 (€6728 and €7375, respectively, p value=0.08) in the UK. The point estimates for the ICERs found that stepwise provisional strategy was cost saving and improved outcomes with a probabilistic sensitivity analysis confirming dominance with an 80% probability.Conclusion The stepwise provisional strategy at 1 year is dominant compared with the systematic dual stenting strategy on both economic and clinical outcomes.