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

• DOI: 10.1136/openhrt-2023-002479
• Publication Date: 2024-01-19T17:50:11Z
• Authors: Alicia Le Bras; David Hildick-Smith; Arnaud Nze Ossima; Olivier Supplisson; Mohaned Egred; Philippe Brunel; Adrian P Banning; Marie-Claude Morice; Isabelle Durand-Z...
• Keywords: Incremental cost-effectiveness ratio; Mace

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 stepwise provisional strategy, compared systematic dual stenting. Aims To estimate 1-year cost-effectiveness versus stenting strategies. Methods Costs France UK, MACE were calculated both groups to incremental ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis conducted from perspective healthcare provider time horizon 1 year. Results cost between two €−755 (€5700 group €6455 group, p value<0.01) €−647 (€6728 €7375, respectively, value=0.08) UK. point estimates for ICERs that strategy saving improved outcomes sensitivity confirming dominance an 80% probability. Conclusion at year is dominant on economic clinical outcomes.