BACKGROUND: There has been a steep increase in the number of percutaneous coronary intervention procedures performed for coronary heart disease since their introduction about 30 years ago. Recently, the use of drug-eluting stents (DES) compared with the original bare metal stents (BMS) has increased in many countries. OBJECTIVE: To assess the cost effectiveness of DES versus BMS in a real-world setting from the Belgian healthcare payer perspective. METHODS: We developed a decision analysis model to estimate incremental costs (year 2004 or 2007 values [depending on the underlying variable]) and effectiveness. Incremental effectiveness was calculated by combining relative benefits from published meta-analyses with real-world observations from a Belgian registry. Probabilistic modelling and sensitivity analyses were performed. The model had a 1-year time horizon. Sixteen sub groups were created based on the following characteristics: initial stent type, diabetic status, complex lesion and multi-vessel disease. Scenario analyses were performed for the influence on reinterventions and the duration of clopidogrel use. In each analysis, 1000 Monte Carlo simulations were performed. RESULTS: The incremental costs for switching from BMS to DES are substantial (approximately euro1000), while the benefits, expressed as QALYs, are extremely small (on average <0.001 QALYs gained). This led to very high incremental cost-effectiveness ratios: over euro860 000 per QALY gained in all subgroups and scenario analyses. CONCLUSION: Comparing DES with BMS, no life-years are gained and small quality-of-life improvements are achieved for short periods, resulting in a high likelihood that DES are not cost effective. When there is competition for scarce resources this should be considered when deciding on the reimbursement of this technology.
BACKGROUND: There has been a steep increase in the number of percutaneous coronary intervention procedures performed for coronary heart disease since their introduction about 30 years ago. Recently, the use of drug-eluting stents (DES) compared with the original bare metal stents (BMS) has increased in many countries. OBJECTIVE: To assess the cost effectiveness of DES versus BMS in a real-world setting from the Belgian healthcare payer perspective. METHODS: We developed a decision analysis model to estimate incremental costs (year 2004 or 2007 values [depending on the underlying variable]) and effectiveness. Incremental effectiveness was calculated by combining relative benefits from published meta-analyses with real-world observations from a Belgian registry. Probabilistic modelling and sensitivity analyses were performed. The model had a 1-year time horizon. Sixteen sub groups were created based on the following characteristics: initial stent type, diabetic status, complex lesion and multi-vessel disease. Scenario analyses were performed for the influence on reinterventions and the duration of clopidogrel use. In each analysis, 1000 Monte Carlo simulations were performed. RESULTS: The incremental costs for switching from BMS to DES are substantial (approximately euro1000), while the benefits, expressed as QALYs, are extremely small (on average <0.001 QALYs gained). This led to very high incremental cost-effectiveness ratios: over euro860 000 per QALY gained in all subgroups and scenario analyses. CONCLUSION: Comparing DES with BMS, no life-years are gained and small quality-of-life improvements are achieved for short periods, resulting in a high likelihood that DES are not cost effective. When there is competition for scarce resources this should be considered when deciding on the reimbursement of this technology.
Authors: Adnan Kastrati; Julinda Mehilli; Jürgen Pache; Christoph Kaiser; Marco Valgimigli; Henning Kelbaek; Maurizio Menichelli; Manel Sabaté; Maarten J Suttorp; Dietrich Baumgart; Melchior Seyfarth; Matthias E Pfisterer; Albert Schömig Journal: N Engl J Med Date: 2007-02-12 Impact factor: 91.245
Authors: R Hill; A Bagust; A Bakhai; R Dickson; Y Dündar; A Haycox; R Mujica Mota; A Reaney; D Roberts; P Williamson; T Walley Journal: Health Technol Assess Date: 2004-09 Impact factor: 4.014
Authors: L T Burgers; E A McClellan; I E Hoefer; G Pasterkamp; J W Jukema; S Horsman; N H J Pijls; J Waltenberger; M A Hillaert; A C Stubbs; J L Severens; W K Redekop Journal: Neth Heart J Date: 2016-02 Impact factor: 2.380