Abstract
BACKGROUND: Drug-coated balloons (DCB) are noninferior to second-generation drug-eluting stents (DES) in the treatment of small vessel coronary artery disease regarding major adverse cardiac events (MACE). However, the economic implication of this finding is unclear. METHODS: In the BASKET-SMALL 2 study (Basel Stent Kosten-Effektivitäts Trial: Drug-Coated Balloons Versus Drug-Eluting Stents in Small Vessel Interventions 2), 738 patients were treated with either DCB or DES and followed up regarding MACE, that is, target vessel revascularization, myocardial infarction, or cardiac death, over 3 years. A cost-effectiveness analysis was performed using German diagnosis-related group data to evaluate total expected costs and quality-adjusted life expectancy, expressed in quality-adjusted life-years, for the entire cohort and each treatment option. RESULTS: DCB led to fewer MACE than DES (14.5% versus 15.3%) but also reduced quality-adjusted life expectancy during the 3-year follow-up (2.35 versus 2.36 quality-adjusted life-years). Regarding direct costs, DCB was less expensive than DES: 5243 versus 5341 EUR during the first 3 years. The incremental cost-effectiveness ratio for DES versus DCB was 6863 EUR per quality-adjusted life-year gained, whereas DCB was more effective and less costly than DES in terms of MACE avoided. Sensitivity analyses emphasized the uncertainty in the results. CONCLUSIONS: Despite reducing the probability of MACE, in terms of quality-adjusted life expectancy DCB was less cost effective than DES at 3 years in the treatment of small vessel coronary artery disease, although results varied substantially when accounting for uncertainty in model parameters.