PharmacoEconomics

, Volume 27, Issue 4, pp 313–327

Cost Effectiveness of Drug-Eluting Stents In Belgian Practice

Healthcare Payer Perspective
  • Mattias Neyt
  • Chris De Laet
  • Annemieke De Ridder
  • Hans Van Brabandt
Original Research Article

DOI: 10.2165/00019053-200927040-00004

Cite this article as:
Neyt, M., De Laet, C., De Ridder, A. et al. Pharmacoeconomics (2009) 27: 313. doi:10.2165/00019053-200927040-00004
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Abstract

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 €1000), 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 €860 000 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.

Supplementary material

40273_2012_27040313_MOESM1_ESM.pdf (158 kb)
Supplementary material, approximately 162 KB.

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Mattias Neyt
    • 1
  • Chris De Laet
    • 1
  • Annemieke De Ridder
    • 2
  • Hans Van Brabandt
    • 1
  1. 1.Belgian Health Care Knowledge CentreBrusselsBelgium
  2. 2.Department of Mathematics, Statistics and Actuarial SciencesUniversity of AntwerpAntwerpBelgium

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