Background In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting. Aims To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies. Methods Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the healthcare provider with a time horizon of 1 year. Results The cost difference between the two groups was €−755 (€5700 in the stepwise provisional group and €6455 in the systematic dual stenting group, p value<0.01) in France and €−647 (€6728 and €7375, respectively, p value=0.08) in the UK. The point estimates for the ICERs found that stepwise provisional strategy was cost saving and improved outcomes with a probabilistic sensitivity analysis confirming dominance with an 80% probability. Conclusion The stepwise provisional strategy at 1 year is dominant compared with the systematic dual stenting strategy on both economic and clinical outcomes. Data are available upon reasonable request.

中文翻译：

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分步式临时支架置入策略与系统性双支架置入策略在左主干远端分叉病变患者中的成本效益：EBC MAIN 试验的经济分析

背景 在需要干预的左主干远端分叉病变患者中，欧洲分叉俱乐部左主冠状动脉支架研究试验发现，主要不良心脏事件（MACE、全因死亡、非致命性心肌梗死和与系统性双支架置入术相比，逐步的临时策略有利于目标病变血运重建。目的 评估逐步临时性双支架置入策略与系统性双支架置入策略的 1 年成本效益。方法 计算两组的法国和英国成本以及 MACE，以估计增量成本效益比 (ICER)。通过概率引导来探索不确定性。该分析是从医疗保健提供者的角度进行的，时间范围为一年。结果 法国两组之间的成本差异为 −755 欧元（逐步临时组为 5700 欧元，系统双支架组为 6455 欧元，p 值<0.01），法国为 −647 欧元（分别为 6728 欧元和 7375 欧元）。 p 值=0.08）在英国。ICER 的点估计发现，逐步的临时策略可以节省成本并改善结果，概率敏感性分析以 80% 的概率确认了主导地位。结论 与系统性双支架策略相比，1 年逐步临时策略在经济和临床结果上均占主导地位。数据可根据合理要求提供。