Cost-Effectiveness of Palmaz-Schatzª Stenting for Patients with Coronary Artery Disease in Italy.

The increasing use of stent implantation in coronary artery disease raises economic concerns for health care decision-makers. This model analysis, which applies to the Italian health care system and uses the latest clinical and economic data, demonstrates coronary stent implantation (CSI) in single-vessel disease (SVD) to be clinically and economically superior to conventional balloon angioplasty (PTCA). Although the procedural cost for CSI remains higher than for PTCA (Lit. 7.5 million vs. Lit. 4.9 million), this cost difference in the cath lab is decreased to approximately Lit. 1.7 million during the in-hospital period due to avoided procedural complications and associated bail-out treatments. By the end of year one, the incremental cost of CSI is totally recouped through savings in revascularization procedures, and the result is maintained over subsequent years. This favorable cost outcome, combined with a higher rate of event-free patients, also improves the cost-effectiveness of CSI, which has a 30.2%, 31.2%, and 32.9% lower cost per event-free survivor than PTCA at the 1-, 2-, and 3-year follow-ups, respectively. In multi-vessel disease, CSI also appears to be a cost-effective alternative to CABG.