Uso do escore de propensão na análise de custo-efetividade com utilização seletiva de stents farmacológicos e não-farmacológicos

Abstract

Background: Studies on the cost-effectiveness ratio of drugeluting stents (DES) are rare. This study aimed to evaluate the results and compare the cost (incremental cost-effectiveness ratio -ICER) per restenosis prevented between DES and bare-metal stents (BMS) using the propensity score. Methods: Two hundred and twenty consecutive patients were included in the study, 111 of whom were treated with DES and 109 with BMS. The propensity score was used to adjust the effect of the intervention by means of matching, stratification and weighting. Results: Most patients were male (67.7% vs. 66.9%; P = 0.53), with a median age of 65.9 years. Patients treated with DES had higher rates of diabetes (54% vs. 17.4%; P < 0.001), three-vessel disease (18.9% vs. 10.1%; P = 0.029) and poor ventricular function (54.1% vs. 22%; P < 0.0001). The diameter of stents was 2.76 ± 0.35 mm vs. 2.91 ± 0.47 mm (P = 0.006), and the sum of the lengths of stents was 37.6 ± 23 mm vs. 24.8 ± 15.8 mm (P < 0.0001). Restenosis was observed in 6.3% vs. 12.8% of the patients (P = 0.099) and in 4.1% vs. 9.8% of the lesions (P = 0.048).

Questão simples, resposta multivariada

“…In Ferreira et al, 6 we observe that the comparison was based on high figures, either that of DES (approximately R$ 11,000) or of BMS (approximately R$ 4,000 -extremely expensive!). Despite the cost relationship between the two treatments, this has not been commonly observed by us.…”

“…In the study published in this issue of the Revista Brasileira de Cardiologia Invasiva, Ferreira et al 6 compared the performance of the Taxus ® DES and the Liberté ® BMS in consecutive, non-randomised patients. Even in countries where the DES/BMS relationship is not as heavily promoted as in this sample, and despite the reduction of restenosis with DES in all subgroups analysed, the development of a model of maximal benefits is necessary.…”

“…This is a first-generation DES that has yielded inferior results compared to those of the second-generation stents. 13 Ferreira et al 6 used an observational, non-randomised, consecutive design, whose results were not monitored or even adjudicated by an independent external committee. Data are analysed under such considerations.…”

Impacto do uso rotineiro de stents farmacológicos na prática intervencionista contemporânea de um centro terciário: experiência de uma década do registro DESIRE

“…1 However, the relatively high cost of this new technology, particularly when compared to the cost of bare-metal stents (BMS), the previous primary intervention, made their incorporation into the routines of most private hospitals in Brazil a slow process, despite the striking benefits of DES, especially in reducing the need for new interventions in the target vessel. [2][3][4] To date, this technology, which has now celebrated ten years of approval for clinical use in Brazil, has not yet been authorized by the public health system. The present study aimed to demonstrate the modifications that have occurred over the past ten years regarding the indication and performance of myocardial revascularization procedures in patients with coronary artery disease in a private tertiary hospital in the state of São Paulo.…”