Cost-Effectiveness of Drug-Eluting Stents Versus Bare Metal Stents in Clinical Practice
What is the cost-effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS)?
The investigators evaluated clinical outcomes and costs of care over 3 years in 1,147 patients undergoing BMS before the availability of DES and 1,247 DES patients at Wake Forest University Baptist Medical Center from 2002 to 2005. Costs for index stenting, repeat target revascularization (TVR), and clopidogrel use were assessed. The primary endpoint for the cost-effectiveness analysis was the incremental cost per repeat TVR avoided over the 3-year study period, in which TVR was considered a surrogate for the inconvenience, and impaired quality of life was associated with repeat revascularization.
The two groups were well matched for baseline characteristics. Index stenting costs were $1,846 higher per patient for DES versus BMS ($1,737 more to $1,950 more). At 3 years, absolute TVR rates were 15.2 per 100 DES patients and 24.1 per 100 BMS patients, and as a result, cumulative TVR-related costs were $2,065 less per patient for DES versus BMS ($3,001 less to $1,134 less). Including the cost of clopidogrel, the incremental cost-effectiveness ratio (ICER) per TVR avoided with DES was $4,731 through 1 year, $4,703 through 2 years, and $6,379 through 3 years.
The authors concluded that the ICER per TVR avoided ranged from $4,703 to $6,379 over 3 years.
This study reports that at 1 year, the ICER for DES was $4,731 per TVR event avoided. At 3 years, the higher cost of DES at the index procedure was completely offset by lower costs of TVR, yet the 3-year ICER was $6,379 per TVR avoided as the result of the need for prolonged use of clopidogrel. These findings provide support for the continued use of DES in clinical practice, but also demonstrate the importance of determining the optimal duration of dual antiplatelet therapy after DES implantation to more accurately define the long-term value of this technology. The availability of generic clopidogrel should make the use of DES even more cost-effective in the future.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention
Keywords: Cost-Benefit Analysis, Protestantism, Drug-Eluting Stents, Quality of Life, Ticlopidine, Stents
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