Document Detail


Cost-effectiveness analyses of drug eluting stents versus bare metal stents: a systematic review of the literature.
MedLine Citation:
PMID:  19135756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Drug eluting stents (DES) used to treat coronary lesions reduce rates of in-stent restenosis and therefore the need for repeat revascularization compared to bare metal stents (BMS). DES, however, are considerably more expensive than BMS. We evaluated whether DES are a cost-effective alternative for BMS. METHODS: Reports of Health Technology Assessment agencies were assessed and a systematic review of economic evaluations comparing DES with BMS was performed. RESULTS: Nineteen full economic evaluations were identified. Some studies indicate that DES may be cost-effective or even cost-saving in specific patients, when used for coronary lesions with a high propensity of restenosis such as long lesions, lesions in narrow vessels, or in patients with diabetes. Other studies mention DES is not cost effective at all with ICERs of more than 200,000 Canadian dollar per QALY gained. One of the main determining factors is the influence of protocol mandated angiographic follow-up in RCTs. The risk for a re-intervention using BMS ranges from 5% to 14% in registries and is much smaller than reported in RCTs (up to 30%). As a result, the absolute reduction in repeat revascularization by DES compared to BMS is smaller in real life. Moreover, using DES instead of BMS does not increase survival or decrease myocardial infarctions. The combination of (a) a higher cost (>euro700) for DES versus BMS; (b) no life-years gained; (c) a relatively small absolute reduction in repeat procedures; and (d) a small improvement in QoL for a short period (less than 0.15 during the first month after the re-intervention), results in unfavourable cost-effectiveness ratios. CONCLUSIONS: Although several studies conclude that DES may be cost effective in large subgroups of patients, under real-world conditions, the cost-effectiveness of DES is unfavourable in comparison with BMS.
Authors:
Mattias Neyt; Hans Van Brabandt; Stephan Devriese; Chris De Laet
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-01-09
Journal Detail:
Title:  Health policy (Amsterdam, Netherlands)     Volume:  91     ISSN:  0168-8510     ISO Abbreviation:  Health Policy     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-15     Completed Date:  2009-09-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8409431     Medline TA:  Health Policy     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  107-20     Citation Subset:  H    
Affiliation:
Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium. mattias.neyt@kce.fgov.be
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MeSH Terms
Descriptor/Qualifier:
Cost-Benefit Analysis*
Drug-Eluting Stents / economics*
Humans
Stents / economics*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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