AIMS: We aimed to assess the cost effectiveness of the sirolimus-eluting stent (SES) in diabetic and non-diabetic patients vs. bare metal stents (BMS). METHODS: EVASTENT was a matched cohort registry of patients undergoing revascularization exclusively with SES; for each diabetic patient (db+) included, stratified according to single (SVD) or multiple (MVD) vessel disease, a non-diabetic patient (db-) was subsequently included. Efficacy, safety and cost data were obtained from the SES database, and then data from the BMS group were derived by using an original method of transition probabilities of events (Markov model and Monte Carlo simulations) if BMS had been implanted in the same patient, over a 3-year time period. Sensitivity analysis was performed by varying the price difference between BMS and SES from 2008 to 2012. RESULTS: In this study, 1731 patients were included with 97% complete follow-up at 3-years. In 2008, compared to BMS the SES was cost effective only in MVD db+ (7494€ per avoided revascularization (PAR) vs. >10,000€ in other groups). In 2012, after a reduction in the price difference between SES and BMS, SES were cost effective in MVD db+ (-891), SVD db+ (3519), MVD db- (3050), and SVD db- (6329) patients. Otherwise, the cardiovascular mortality rate was higher (p<0.0001) in MVD db+ than in SVD db+, MVD db- and SVD db-. CONCLUSION: The SES is now cost effective in diabetic and non-diabetic patients, after a favorable price evolution between drug eluting and bare metal stents.
AIMS: We aimed to assess the cost effectiveness of the sirolimus-eluting stent (SES) in diabetic and non-diabeticpatients vs. bare metal stents (BMS). METHODS: EVASTENT was a matched cohort registry of patients undergoing revascularization exclusively with SES; for each diabeticpatient (db+) included, stratified according to single (SVD) or multiple (MVD) vessel disease, a non-diabeticpatient (db-) was subsequently included. Efficacy, safety and cost data were obtained from the SES database, and then data from the BMS group were derived by using an original method of transition probabilities of events (Markov model and Monte Carlo simulations) if BMS had been implanted in the same patient, over a 3-year time period. Sensitivity analysis was performed by varying the price difference between BMS and SES from 2008 to 2012. RESULTS: In this study, 1731 patients were included with 97% complete follow-up at 3-years. In 2008, compared to BMS the SES was cost effective only in MVD db+ (7494€ per avoided revascularization (PAR) vs. >10,000€ in other groups). In 2012, after a reduction in the price difference between SES and BMS, SES were cost effective in MVD db+ (-891), SVD db+ (3519), MVD db- (3050), and SVD db- (6329) patients. Otherwise, the cardiovascular mortality rate was higher (p<0.0001) in MVD db+ than in SVD db+, MVD db- and SVD db-. CONCLUSION: The SES is now cost effective in diabetic and non-diabeticpatients, after a favorable price evolution between drug eluting and bare metal stents.
Authors: Wolfgang Hohenforst-Schmidt; Paul Zarogoulidis; Georgia Pitsiou; Bernd Linsmeier; Drosos Tsavlis; Ioannis Kioumis; Eleni Papadaki; Lutz Freitag; Theodora Tsiouda; J Francis Turner; Robert Browning; Michael Simoff; Nikolaos Sachpekidis; Kosmas Tsakiridis; Bojan Zaric; Lonny Yarmus; Sofia Baka; Grigoris Stratakos; Harald Rittger Journal: J Cancer Date: 2016-01-13 Impact factor: 4.207
Authors: Nicole Ferko; Giuseppe Ferrante; James T Hasegawa; Tanya Schikorr; Ireena M Soleas; John B Hernandez; Manel Sabaté; Christoph Kaiser; Salvatore Brugaletta; Jose Maria de la Torre Hernandez; Soeren Galatius; Angel Cequier; Franz Eberli; Adam de Belder; Patrick W Serruys; Marco Valgimigli Journal: Catheter Cardiovasc Interv Date: 2016-08-16 Impact factor: 2.692