68 A comparative study of the economics and safety of intravascular lithotripsy versus rotational atherectomy for calcium modulation in percutaneous coronary intervention: a uk tertiary centre experience

Abstract

<h3>Introduction</h3> Intravascular lithotripsy (IVL) [Shockwave Medical Inc] is a relatively novel method of treating complex, calcified coronary lesions and is becoming a fundamental staple of the coronary calcium modulation algorithm. When compared to rotational atherectomy (RA) [Boston Scientific], it has lower procedural complication rates.Objective: To compare the real-world costs and utilisation of resources, procedural and 30 days complications, radiation exposure and contrast volume use between IVL and RA at the Trent Cardiac Centre (TCC), Nottingham University Hospitals NHS Trusts - a tertiary UK cardiac centre. <h3>Method</h3> Consecutive patients undergoing percutaneous coronary intervention (PCI) where IVL was utilised (n=12) were compared to consecutive patients where RA was utilised (n=12) in 2021/22 at TCC. Patients’ data were electronically retrieved from the hospital’s cardiovascular electronic system TOMCAT [Philips]. Patients’ demographics and risk factors, periprocedural events, procedural time, contrast volume and radiation doses were analysed and compared in both groups. Incidence of major adverse cardiovascular events (MACE) and hospital re-admissions over the following 30 days were recorded. Cost data was calculated using the NHS Patient Level Information and Costing System (PLICS). Continuous data are expressed as a mean ± 2 standard deviations and p-values calculated using one-tailed Student’s t-test. <h3>Results</h3> The mean age was 74.8 ± 8.8 years in the IVL groups vs. 77.2 ± 9 years in the RA group, p=0.26. Numerically, the proportion of females was higher in IVL group as well as the presence of vascular risk factors such as hypertension, hyperlipidaemia, and smoking history. In the RA group, two procedural complications were reported (side branch occlusion and coronary dissection) whereas only one complication (femoral site access haematoma) was recorded in IVL group (p&lt;0.07). No MACE events at 30 days were recorded in either group. There were no significant differences in procedural time (mean difference 15 mins, IVL = 128 ± 29 mins vs. RA = 113 ± 27 mins, p=0.22), contrast volume use (mean difference 34 ml, IVL = 210 ± 48 ml vs. RA = 176 ± 47 ml, p=0.16) or Dose Area Product (DAP) radiation exposure (mean difference 956 Gycm2, IVL = 4803 ± 1,604Gycm2 vs. RA =5,759 ± 3,326Gycm2, p=0.29). The cost of the IVL balloon was identical in cost to the RotaLink™ plus in our institution, at around £1440. There was no statistical difference in the procedural costs between the two groups (procedural costs mean difference £368, IVL = £3759 ± 867 vs. RA = £4128 ± 901, p&lt;0.26), but the overall costs, which included inpatient and outpatient costs, pathology, radiology and staff costs projected out to 1 year, were significantly lower with PCI with IVL vs. PCI with RA (overall costs mean difference £3,120, IVL = £10,626 ± 2,876 vs. RA = £13,746 ± 2,536, p&lt;0.04) (Figure1). <h3>Conclusion</h3> There were no significant differences in levels of radiation exposure, contrast volume used or length of the procedure comparing IVL with RA. There was significant overall cost reduction with the use of IVL in complex PCI procedures with cost effectiveness being predicted over the following year. Future randomised trials of new PCI technologies should include a formal health economic analysis. <h3>Conflict of Interest</h3> None