Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction: Cost-Effectiveness Analysis of the REVIVED-BCIS2 Trial
Authors: Chivardi Carlos , Morgan Holly , Sculpher Mark J. , Clayton Tim , Evans Richard , Dodd Matthew , Petrie Mark , Rinaldi Christopher A. , O'Kane Peter , Brown Louise , Perera Divaka , Saramago Pedro , Perera Divaka , Chiribiri Amedeo , Carr-White Gerry , Pavlidis Antonis , Redwood Simon , Clapp Brian , Rinaldi Aldo , Rahman Haseeb , Briceno Natalia , Arnold Sophie , Raynsford Amy , Wilson Karen , Clack Lucy , Petrie Mark , McEntegart Margaret , Watkins Stuart , Shaukat Aadil , Rocchiccioli Paul , McAdam Marion , McPherson Elizabeth , Cowan Louise , Wood Marie , Weerackody Roshan , Davies Ceri , Smith Elliot , Modi Bhavik , Mathew Bindu , Mitchelmore Oliver , Adrego Rita , Andiapen Mervyn , O’Kane Peter , Din Jehangir , Kennard Sarah , Orr Sarah , Purnell Cathie , Greenwood John , Blaxill Jonathan , Mozid Abdul , Anderson Michelle , Somers Kathryn , Dixon Lana , Walsh Simon , Spence Mark , Glover Patricia , Brown Caroline , Amin-Youssef George , Shah Ajay , McDonagh Theresa , Byrne Jonathan , Pareek Nilesh , Breeze Jonathan , Antao Catherine , De Silva Kalpa , Strange Julian , Johnson Tom , Nightingale Angus , Gallego Laura , Medina Cristina , Gershlick Anthony , McCann Gerald , Ladwiniec Andrew , Squire Iain , Davison Joanna , Kenmuir-Hogg Kris , Spratt James , Cosgrove Claudia , Williams Rupert , Firoozi Sam , Lim Pitt , Bonato Giovanna , Sookhoo Vennessa , Conway Dwayne , Brooksby Paul , Wright Judith , Exley Donna , Cotton James , Horton Richard , Metherell Stella , Smallwood Andrew , Hogrefe Kai , Cheng Adrian , Beirnes Charmaine , Sidgwick Sian , Lockie Tim , Patel Niket , Rakhit Roby , Davies Nina , Smit Angelique , Ahmed Fozia , Hendry Cara , Fath-Odoubadi Farzin , Fraser Douglas , Mamas Mamas , Oommen Anu , Charles Thabitha , Behan Miles , Japp Alan , Rif Belinda , Jenkins Nicholas , McClure Sam , Oates Pauline , Martin Karen , Abdelaal Eltigani , Sarma Jaydeep , Shastri Sanjay , Riley Jo , Giannopoulou Sarra , Quinn Sophie , Magapu Pradeep , Stables Rod , Wright David , Barton Janet , Clarkson Nichola , Mahmoudi Michael , Flett Andrew , Curzen Nick , Radmore Judith , Gough Sam , Ludman Andrew , Kurdi Hibba , Keenan Samantha , Banerjee Prithwish , Tapp Luke , Edwards Nigel , Gibson Catherine , Kukreja Neville , Lynch Mary , Barratt Claire , de Belder Mark , Thambyrajah Jeet , Swanson Neil , Richardson Cath , Atkinson Bev , Viswanathan Girish , Waugh Darren , Routledge Helen , Trevelyan Jasper , Doughty Angela , Pegge Nick , Dhamrait Sukhbir , Moore Sally , Galasko Gavin , Cassidy Christopher , Waddington Natalia , Edwards Tim , Iqbal Javed , Witherow Fraser , Birch Jenny , Munro Melanie , Wells Tim , Sinha Manas , Frost Linda , Lee Kaeng , Beattie James , Pitt Mike , Chung Alan , Ramcharitar Steve , McCafferty Laura , Martin Thomas , Irving John , Iskandar Zaid , Hutcheon Anita , Gunn Julian , Al-Mohammad Abdallah , Agyemang Michael , Griffiths Huw , Kalra Paul , Howe Serena , Gray Tim , Sobolewska Jolanta , Morby Louise , Glover Jason , Beynon James , Knight Janet , Das Paul , Bellamy Chris , Harman Emily , Pye Mr Maurice , Megarry Simon , McGill Yvonne , Redfearn Heidi 
Published: November 2023

BACKGROUND:
Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone.

METHODS:
REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors.

RESULTS:
Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0.

CONCLUSIONS:
A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01920048.