Background: Cost-utility analyses of percutaneous coronary interventions (PCIs) provide valuable insights into the economic value of these procedures. This analysis aimed to compare the cost-utility of different treatment modalities used for PCI patients within a Thai PCI registry. Methods: Clinical and quality-of-life data from 39 hospitals spread throughout Thailand were used in this analysis. Three treatment modalities for PCI procedures were compared: a) radial vs. femoral access, b) partial vs. complete revascularization for multivessel coronary artery disease, and c) use vs. non-use of device-guided PCIs (intracoronary ultrasound, optical coherence tomography or fractional flow reserve). Cost data were obtained from each patient's bill for their hospital stay. Utility scores were measured using the Thai EQ-5D-5L at admission, discharge, and one-year post-procedure. The incremental cost-effectiveness ratio (ICER) was then estimated and used for each comparison. Results: Of 19,701 patients enrolled in 2018-19, approximately one-third (n=7,332) had hospital cost data available for analysis. At discharge, the mean costs associated with radial access and partial revascularization were $986 and $391, respectively, less than the costs for device-guided PCIs, which increased by a mean of $2004. The delta utility gains for these approaches were 2.97, 1.60, and 1.07 at discharge and 1.08, 1.06, and 0.29 at one year, respectively. The estimated ICERs at one year were -$894, -$359, and $7041 per unit of utility gained, respectively. Conclusion: Radial access and partial revascularization demonstrated cost-effectiveness, while device-guided PCI incurred high costs for the achieved utility scores. Identifying the factors that influence these outcomes may assist clinicians in tailoring interventions to optimize a patient?s quality of life after PCI.

The authors have declared no competing interest.

This analysis utilized data from the nationwide multicenter Thai PCI Registry, initiated in 2018 by the Cardiac Intervention Association of Thailand. The research methodology has been described in detail elsewhere.

https://doi.org/10.35755/jmedassocthai.2021.10.13066

This project received a research grant from the Health System Research Institute of the Ministry of Public Health, Bangkok, Thailand.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The analysis was approved by the Faculty of Medicine Ethics Committee, Ramathibodi Hospital, Mahidol University (COA?MURA2022/205).

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The data supporting the findings of this study are available from the corresponding author upon reasonable request.