Intravascular ultrasound-guided interventions in coronary artery disease: a systematic literature review, with decision-analytic modelling, of outcomes and cost-effectiveness.

Abstract

Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see overleaf). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme. This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening. The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels. The research reported in this monograph was funded as project number 96/35/01. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Assessment of coronary stent deployment using computer enhanced x‐ray images‐validation against intravascular ultrasound and best practice recommendations

“…However, routine IVUS adds cost, time and increases the risk procedural complications, with little or no effect on rates of subsequent death or myocardial infarction (MI) . The cost‐effectiveness of IVUS guidance ofr PTCA is unproven . Quicker, cost effective and less invasive means of improving recognition of stent under‐deployment is therefore desirable.…”

Interventional cardiology in Israel at 2005—state of practice

“…Selective application of coronary diagnostic and therapeutic tools: Physicians avoided using devices that had no demonstrable effects on patient outcomes. Although, the literature is saturated with favorable reports regarding the cost effectiveness of pre and post-procedural lesion analysis, by both intra-vascular ultrasound (IVUS) (9,10) and Pressure-wire (11), some objective assessments failed to reach similar conclusions (12). The European interventionalist avoided the cost of IVUS assessment, by routine high-pressure stent deployment with occasional high-pressure post stenting non-compliant balloon inflations.…”

Does intravascular ultrasound provide clinical benefits for percutaneous coronary intervention with bare-metal stent implantation? A meta-analysis of randomized controlled trials

“…The first published systematic review evaluated the role of IVUS in PCI as well as its cost-effectiveness and did not show any difference between IVUS and angio-guided PCI [11]. A few years later, a meta-analysis did not show any reduction in death or myocardial infarction (MI) but revealed reductions in repeat revascularization and angiographic restenosis after a six-month follow-up [12].…”