Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

Abstract

ObjectiveTo determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES.MethodsA cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117 762 patient-years with 76 randomised trials. The main effectiveness criterion was major cardiac event-free survival. Effectiveness and costs were modelled over a 5-year horizon using a three-state Markov model. Incremental cost-effectiveness ratios and a cost-effectiveness acceptability curve were calculated for a range of thresholds for willingness to pay per year without major cardiac event gain. Deterministic and probabilistic sensitivity analyses were performed.ResultsBase case results demonstrated that DES are dominant over BMS, with an increase in event-free survival and a cost-reduction of €184, primarily due to a diminution of second revascularisations, and an absence of myocardial infarction and stent thrombosis. These results are robust for uncertainty on one-way deterministic and probabilistic sensitivity analyses. Using a cost-effectiveness threshold of €7000 per major cardiac event-free year gained, DES has a >95% probability of being cost-effective versus BMS.ConclusionsFollowing DES price decrease, new-generation DES development and taking into account recent meta-analyses results, the DES can now be considered cost-effective regardless of selective indication in France, according to European recommendations.

Trends in Characteristics and Outcomes of Hospital Inpatients Undergoing Coronary Revascularization in the United States, 2003-2016

“…These trends likely reflect the effect of the emerging data that suggest the incremental benefit of certain techniques or devices (eg, fractional flow reserve, drug-eluting stents, and arterial conduits) and the limited value of others (eg, off-pump bypass). [31][32][33][34][35][36][37][38] We hypothesized that the temporal decrease in PCI and CABG volume, as well as the accompanying changes in hospital inpatient risk profile and procedural characteristics, might have been associated with a change in procedural mortality over time. We thus evaluated crude and riskadjusted rates of in-hospital mortality of both procedures stratified by indication.…”

Cost-effectiveness analysis of the SAPIEN 3 TAVI valve compared with surgery in intermediate-risk patients

“…the Canadian analyses utilize a bottom-up unit cost allocation according to clinical data and expert opinion, vs the analysis presented here which is based on real world cost data by admission and reflects the true costs to the payer for TAVI and, critically, for sAVR. Moreover, to our knowledge TAVI is highly unusual in being both clinically beneficial and cost saving in comparison with other technologies where analyses are based on empirical French cost data derived from current practice [18][19][20][21] .…”

Cost‐effectiveness analysis of biodegradable polymer versus durable polymer drug‐eluting stents incorporating real‐world evidence

“…Given its gradual and progressive onset, restenosis has been perceived as a benign phenomenon; thus, the impact of ISR was modeled through its presentation as MI by a proportion of patients who experienced ISR. Similar to the first 30 days, patients were at risk of cardiac death (excluding fatal MI due to ST or ISR and unrelated to stent failure) and noncardiac death. Procedural‐related death rates for PCI and CABG were obtained from published sources…”

“…Given that patients in the real‐world setting have more complex lesions and other comorbidities, the benefits of BP‐DES implantation remain uncertain. To date, numerous economic evaluations have compared DES with bare metal stents but there are no known cost‐effectiveness data assessing BP‐DES versus DP‐DES. In the current healthcare environment, cost‐effectiveness analysis is important to determine the value of new technologies by quantifying the benefits and costs of different treatment options.…”