Cost Effectiveness of Drug-Eluting Stents In Belgian Practice
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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.
KeywordsPercutaneous Coronary Intervention Clopidogrel Bare Metal Stents Late Stent Thrombosis Stent Restenosis
Researchers from the University of Antwerp received funding from the Belgian Health Care Knowledge Centre (KCE) for their contribution to the Health Technology Assessment report on drug-eluting stents (research project 2006–08). The authors received no sources of funding to assist in the preparation of this study. The authors have no conflicts of interest relevant to the content of this study.
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