{Reference Type}: Journal Article
{Title}: Do coronary stent policies affect the cost-effectiveness of percutaneous coronary intervention among patients with acute coronary syndrome in Shanghai? A retrospective cohort study based on real-world and propensity score-matched data.
{Author}: Lu D;Shao Z;Wang Y;Xue D;
{Journal}: BMJ Open
{Volume}: 14
{Issue}: 6
{Year}: 2024 Jun 19
{Factor}: 3.006
{DOI}: 10.1136/bmjopen-2023-083456
{Abstract}: <B>OBJECTIVE: </B>This study aimed to assess whether the national centralised volume-based procurement policy and the Shanghai government's supportive measures (coronary stent policies) implemented in Shanghai, China, on 20 January 2021 affected the cost-effectiveness of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in the year after surgery.<BR><B>METHODS: </B>A retrospective cohort study based on real-world data and propensity score (PS)-matched data was conducted to compare the cost-effectiveness of PCI before and after policy implementation.<BR><B>METHODS: </B>Patients with ACS who had undergone first-time PCI over 1 year previously in hospitals in Shanghai and were discharged between 1 March 2019 and 30 April 2022 were included in the study.<BR><B>METHODS: </B>In the present study, cost was defined as total direct medical expenses, and effectiveness was defined as the prevention of major adverse cardiac events (MACEs). Incremental cost-effectiveness ratios (ICERs) were used to measure the cost-effectiveness of PCI in patients with ACS 1 year after surgery.<BR><B>RESULTS: </B>The study included 31 760 patients. According to real-world and PS-matched data, the implementation of coronary stent policies in Shanghai reduced the total medical cost of patients with ACS 1 year after PCI by 24.39% (p<0.0001) and 22.26% (p<0.0001), respectively. The ICERs were ¥-1131.72 and ¥-842.00 thousand per MACE avoided, respectively. The ICERs were robust to parameter uncertainty, and there was a substantial chance for policy implementation to improve the cost-effectiveness of PCI among patients with ACS in the short term.<BR><B>CONCLUSIONS: </B>The implementation of coronary stent policies has improved the cost-effectiveness of PCI for patients with ACS in the short term. The long-term impact of coronary stent policies on the cost-effectiveness of PCI in patients with ACS or other coronary heart diseases should be assessed in the future.