Cost-Utility Analysis of Covered vs. Bare Metal Stenting of the Mesenteric Arteries in Patients with Chronic Mesenteric Ischaemia: Results of a Multicentre Randomised Controlled Trial (CoBaGI).

Abstract

Chronic mesenteric ischaemia caused by atherosclerotic mesenteric artery stenosis is usually treated endovascularly. Covered stents (CS) have shown superior long term patency compared with bare metal stents (BMS), but their cost utility remains unclear. The aim of this study was to evaluate the 24-month cost-utility of CS vs. BMS from a healthcare perspective, expressed in costs and quality adjusted life years (QALYs). Data from 94 patients in a multicentre randomised controlled trial, powered to compare twenty-four month stent patency between CS and BMS, were analysed. Costs included (re-)intervention(s), inpatient and outpatient costs. QALYs were derived from utilities. Missing data were imputed. Incremental cost effectiveness was assessed using seemingly unrelated regression and non-parametric bootstrapping. Incremental net benefit and cost-effectiveness acceptability curves (CEACs) were used to evaluate cost-effectiveness probability across common willingness-to-pay (WTP) thresholds. Threshold analyses evaluated the robustness of cost-effectiveness across differences in acquisition costs between CS and BMS. CS were associated with lower mean total costs (€14 036 [95% confidence interval {CI} €11 168 - €16 905] vs. €15 955 [95% CI €12 118 - €19 793]) and higher mean QALYs (1.23 [95% CI 1.09 - 1.37] vs. 1.17 [95% CI 1.03 - 1.32]) compared with BMS, yielding a dominant strategy with 60% bootstrap replicates in the southeast quadrant of the cost-effectiveness plane. The CEACs demonstrated a high probability of CS being cost-effective, increasing from 79% to 84% at €80 000 per QALY. Threshold analyses showed that CS probably remained cost saving up to additional acquisitions costs of €1 500 per stent, and cost effectiveness even beyond €4 000 per stent (WTP = €50 000). Over 24 months, CS were associated with modest QALY gains and lower mean costs compared with BMS, resulting in a high probability of being cost-effective across commonly used WTP thresholds. While some uncertainty remains, the overall findings suggest that CS are likely to provide an economic advantage.