Economic modeling of new stent platforms to evaluate cost effectiveness: analysis of the TAXUS Liberté versus TAXUS express stents.

Background: With the changing health care environment, cost effectiveness is an important adjunct to clinical investigation when assessing new medical devices. This study presents an economic model to evaluate cost effectiveness of coronary stents. Methods: Markov modeling was developed comparing total costs (Medicare payer perspective) between TAXUS Liberte and TAXUS Express based on 3-year clinical outcomes from the TAXUS ATLAS Small Vessel and Long Lesion trials. Results: The TAXUS Liberte 2.25-mm stent provided cost savings relative to TAXUS Express from a payer perspective ($17,605 vs. $20,281), driven by reduced target vessel revascularization (0.16 events/patient vs. 0.33 events/patient). In probabilistic sensitivity analyses, TAXUS Liberte was less costly with fewer major adverse cardiac events in over 99% of parameter sets. The TAXUS Liberte Long (38 mm) stent was cost neutral relative to TAXUS Express from a payer perspective ($18,545 vs. $18,551) with fewer myocardial infarctions and cardiac deaths. Accounting for angiography-driven revascularizations, TAXUS Liberte 2.25 mm still provided cost savings relative to TAXUS Express ($16,822 vs. $19,139), although TAXUS Liberte Long was more expensive than TAXUS Express ($17,886 vs. $17,652). From a hospital perspective, TAXUS Liberte Long provided cost savings up to a price premium of $671/stent, driven by fewer stents employed per patient. Conclusions: This analysis confirms the utility of economic modeling in assessing new stent platforms. TAXUS Liberte 2.25 mm is economically dominant relative to TAXUS Express when treating small vessels. TAXUS Liberte Long is cost neutral to modestly more costly than TAXUS Express 2.25 mm from a payer perspective. (J Interven Cardiol 2012;25:353363)