Cost-effectiveness analysis of intravascular ultrasound guided percutaneous coronary intervention versus conventional percutaneous coronary intervention

Objective-Investigation of the cost-effectiveness of intravascular ultrasou nd (IVUS) guided percutaneous coronary intervention (PCI) compared to PCI g uided by coronary angiography (CAG). Methods-One hundred and eight men referred for PCI, were randomized to IVUS or CAG guided PCI. After 6 months, the patients were subjected to a study related clinical and invasive follow-up investigation by GAG, IVUS and intr acoronary Doppler flow measurements. Incremental costs of IVUS guided proce dures and costs of reinterventions were estimated using the Activity Based Costing (ABC) method. Results-Patients randomized to IVUS guided PCI experienced an improved clin ical outcome, with lower angina levels than patients in the CAG guided grou p. The initial cost of performing IVUS guidance was increased due to extra procedure time, IVUS catheters and slightly more balloons and stents, but f ewer patients in the IVUS guided group needed re-intervention. Overall, the se savings outweighed the initial cost increase. Conclusion-Our data suggest that when performing IVUS guided PCI, costs as well as benefits increase. The increased benefits measured as cost savings resulting from less restenosis outweigh the cost increase from performing t he IVUS guided PCI as opposed to CAG guided PCI.