Michishita I, Geisler BP, Ikeno F, Pietzsch JB. Cost-effectiveness of orbital compared to rotational atherectomy of severely calcified coronary artery lesions in Japan [abstract PMD42]. Poster presentation to the 2017 annual meeting of the International Society for Pharmacoeconomics and Outcomes Research, Boston, 20–24 May 2017. Value Health. 2017;20(5):A243.

Objectives. Percutaneous treatment of severely calcified coronary artery lesions is associated with lower procedural success and higher complication rates compared to non-calcified lesions, and continues to present a clinical and economic challenge. Compared to rotational atherectomy (RA), orbital atherectomy (OA) has been shown to decrease procedure failure and reintervention rates. Our objective was to explore the cost-effectiveness of OA compared to RA in the Japanese healthcare system.

Methods. A decision-analytic model calculated reintervention rates and consequent total one-year costs. Effectiveness inputs were therapy-specific target lesion revascularization (TLR) rates and all-cause mortality, pooled from identified clinical studies. Index and reintervention costs were determined via claims data analysis of n=33,628 subjects treated in Japan between April 2014 and March 2016. We computed incremental cost-effectiveness in ¥ per life year (LY) gained based on differences in one-year cost and projected long-term survival. In the absence of a final reimbursement amount, we assumed an OA device cost of ¥500,000, and tested a range of ¥350,000 to ¥650,000.

Results. Total one-year costs were ¥75,478 higher with OA compared to RA (¥2,765,239 vs. ¥2,689,761). Higher index procedure device and accessory costs for OA (¥567,800 vs. ¥365,850) were largely reclaimed at 1-year follow-up, because of lower 12-month target lesion revascularization rates (5.0% vs. 15.7%). Based on one-year mortalities of 5.5% and 6.8% for OA and RA, projected mean survival was 8.34 and 8.16 LYs respectively (+0.17), resulting in an ICER of ¥439,214. OA was the dominant strategy for device cost less than ¥465,000, and reached a maximum ICER of ¥1,079,314 at device cost of ¥650,000. Findings were robust across a wide range of clinical and utilization assumptions.

Conclusions. Orbital atherectomy for the treatment of severely calcified coronary artery lesions is a cost-effective and potentially cost-saving treatment approach in the Japanese healthcare system. Future confirmatory analyses are warranted.