Custo-efetividade do Stent Farmacológico na Intervenção Coronariana Percutânea no SUS

Abstract

Background: The use of drug-eluting stents (DESs), compared with bare-metal stents (BMSs), in percutaneous coronary intervention (PCI) has reduced the rate of restenosis, without an impact on mortality but with an increase in costs. Medical literature lacks randomized studies that economically compare these 2 stent types within the reality of the Brazilian Unified Public Health System (SUS). Objective: To estimate the incremental cost-effectiveness ratio (ICER) between DES and BMS in SUS patients with singlevessel coronary artery disease. Methods: Over a 3-year period, patients with symptomatic single-vessel coronary artery disease were randomized in a 1:2 ratio to receive a DES or BMS during PCI, with a 1-year clinical follow-up. The evaluation included instent restenosis (ISR), target lesion revascularization (TLR), major adverse events, and cost-effectiveness for each group. P-values <0.05 were considered significant. Results: In the DES group, of 74 patients (96.1%) who completed the follow-up, 1 developed ISR (1.4%), 1 had TLR (1.4%), and 1 died (1.4%), with no cases of thrombosis. In the BMS group, of 141 patients (91.5%), ISR occurred in 14 (10.1%), TLR in 10 (7.3%), death in 3 (2.1%), and thrombosis in 1 (0.74%). In the economic analysis, the cost of the procedure was R$ 5,722.

Stents Farmacológicos para Todos: o Preço Vale a Pena?

“…But it has not be used as a threshold for cost-effectiveness analyses that consider other outcomes not directly related to survival. Although analyzing a different outcome, Pessoal et al 7 highlights that the cost increase for providing access to DES is not as high as it has been previously considered. Finally, efforts have recently been made by the Brazilian government to further improved analysis of cost-effectiveness of our major Universal Health Care system in the world.…”

“…8,9 If the ICER for a new technology falls below £20 000 (UK) or $50,000 (US) per QALYs gained, that technology is generally recommended for purchase by the national health system. Nonetheless, as stated by Pessoa et al, 7 there is no clear ICER threshold in Brazil as a guidance to incorporate drugs and devices in the public health system. Indeed, the cost-effectiveness thresholds suggested by the WHO for use in low-and middle-income countries is 1 to 3 times GDP per capita 10 by disability adjusted life year (DALY) saved, which is not the outcome considered by the autors.…”

“…Indeed, the cost-effectiveness thresholds suggested by the WHO for use in low-and middle-income countries is 1 to 3 times GDP per capita 10 by disability adjusted life year (DALY) saved, which is not the outcome considered by the autors. Yet the threshold of R$ 31.587,00 used by Pessoa et al 7 was initially developed for analysis by DALY saved, then became used as a threshold for the cost-effectiveness limit of analysis by QALY saved and even by life-year saved. But it has not be used as a threshold for cost-effectiveness analyses that consider other outcomes not directly related to survival.…”

“…To date, DES have not yet been incorporated as default device for any PCI in the setting of the Brazilian Public Health System-despite the official approval by Ordinance No. 29 issued by the Ministry of Health in 2014+ 6 Costs of DES have decreased in recent years and their second-generation development raises a need for evaluation of the cost-effectiveness of DES versus BMS.Pessoa et al7 must be congratulated by performing a thoroughly randomized 2:1 comparison of BMS versus second-generation DES PCI strategies for 231 consecutive patients with single-vessel coronary disease plus symptoms and/or significant ischemia burden, for whom planed single stent PCI was sought to be feasible, in the setting of Brazilian Public Health System. The aim was to evaluate the ICER and major adverse events of DES versus BMS.…”

Análise temporal da realização da revascularização miocárdica em pacientes hospitalizados pelo Sistema Único de Saúde brasileiro nos últimos 10 anos

“…Igualmente,Pessoa et al (2020) eYock et al (2003) concluiu por meio da análise do custo-benefício entre a angioplastia com implantação de stents e a CRVM, considerando o índice que qualidade de vida, que a CRVM possui melhores resultados com menores custos.…”