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Medikamentenfreisetzende Stents der 2. Generation

Neu, aber auch kosteneffektiv?

Second-generation DES

New, but also cost-effective?

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Zusammenfassung

Die vorliegende Arbeit hat zum Ziel, die bestehende Evidenz zur Kosteneffektivität von medikamentenfreisetzenden Stents (DES) der 2. Generation zusammenzufassen und im Vergleich mit „Bare-metal“-Stents (BMS) und DES der 1. Generation zu beurteilen. Hierzu wurden eine strukturierte Literaturrecherche in Medline durchgeführt und die Ergebnisse relevanter Publikationen anhand vorab definierter Selektionskriterien und standardisierter Extraktionsbögen zusammengefasst. Von den insgesamt 5 verfügbaren Kosteneffektivitätsanalysen aus den USA, aus Großbritannien und Spanien verglichen 3 Studien den Zotarolimus-beschichteten Endeavor-Stent (ZES) mit BMS und 2 Studien den ZES mit DES der 1. Generation. Zusammenfassend lässt sich feststellen, dass die Datenlage zur Beurteilung der Kosteneffektivität von DES der 2. Generation insbesondere in Deutschland gegenwärtig unzureichend ist. Die identifizierten Untersuchungen aus anderen Gesundheitssystemen geben jedoch gewisse Hinweise darauf, dass weder im Vergleich mit BMS noch mit DES eine überlegene Kosteneffektivität des ZES besteht. Darüber hinaus ist festzustellen, dass Kosteneffektivitätsanalysen des Everolimus-beschichteten Xience-V-Stent aktuell fehlen. Methodisch verlässliche Studien, die die Kosteneffektivität von DES der 2. Generation im deutschen Gesundheitssystem auch innerhalb wichtiger Subgruppen untersuchen, sind somit dringend indiziert.

Abstract

Background

The objective of the present review was to investigate the cost-effectiveness of second-generation drug-eluting stents (DES) compared to bare metal stents (BMS) as well as to first-generation DES.

Methods

A structured literature review in MEDLINE was conducted to identify all studies investigating the cost-effectiveness of second-generation DES published up to December 2010. Pre-specified selection criteria were applied to identify relevant studies. Standardized data extraction was performed to summarize clinical, economic, and cost-effectiveness outcomes of these studies.

Results

Of only five studies which met all selection criteria from the US, UK, and Spain, three investigated the cost-effectiveness of the zotarolimus-coated Endeavor stent (ZES) compared to BMS, and two studies the ZES with first-generation DES.

Conclusion

In summary, there is currently a lack of evidence with regard to the cost-effectiveness of second-generation DES, especially in Germany. However, studies from other countries provide some evidence that second-generation DES appear to generally not be cost-effective compared to BMS. Also, there is no conclusive evidence of cost-effectiveness compared to first-generation DES. Moreover, there are currently no studies investigating the cost-effectiveness of the Everolimus-coated Xience V stent. Methodologically rigorous economic evaluations addressing these issues within the context of the German health care system are therefore urgently required.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Forschungsförderung des Instituts für Sozialmedizin durch Cordis und Boston Scientific in den vergangenen Jahren.

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Authors and Affiliations

  1. Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Deutschland

    F. Müller-Riemenschneider MSc, T. Reinhold & S.N. Willich

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  1. F. Müller-Riemenschneider MSc
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  2. T. Reinhold
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  3. S.N. Willich
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Correspondence to F. Müller-Riemenschneider MSc.

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Müller-Riemenschneider, F., Reinhold, T. & Willich, S. Medikamentenfreisetzende Stents der 2. Generation. Herz 36, 254–261 (2011). https://doi.org/10.1007/s00059-011-3463-2

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