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Cost Effectiveness of the Sirolimus-Eluting Stent in High-Risk Patients in Canada

An Analysis from the C-SIRIUS Trial

  • Original Research Article
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Abstract

Background

The cost effectiveness of drug-eluting stents in Canada is debated and deserves further evaluation in high-risk patients.

Methods

We performed an economic analysis from the third-party payer perspective based on the clinical results and resource-utilization data of the C-SIRIUS (The Canadian Study of the Sirolimus-Eluting Stent in the Treatment of Patients with Long De Novo Lesions in Small Native Coronary Arteries) trial, which examined the safety and efficacy of sirolimus-eluting stents (SES) versus bare metal stents (BMS) in high-risk patients with single long de novo lesions in small coronary arteries. Only inpatient costs were considered, including physician fees. We postulated that the incremental cost required to avoid a repeat revascularization (RR) procedure with BMS versus simple balloon angioplasty (BA) could be considered the willingness to pay (WTP) to avoid restenosis in Canada. We assessed the incremental cost-effectiveness ratio (ICER) of SES compared with BMS in these high-risk patients compared with WTP. Results are expressed in 2003 Canadian dollars.

Results

With a 7% absolute reduction in the need for RR compared with BA, BMS are associated on average with an ICER of $12 551/RR avoided (RRA) in Canada. In C-SIRIUS, SES further reduced the need for RR at 1 year from 22% to 4% (p = 0.015) compared with BMS. With a 1.5 stent-to-lesion (STL) ratio and an SES retail price of $2700 compared with $700 for BMS, the ICER of SES versus BMS was $11 275/RRA — borderline cost effective compared with the implicit WTP of $12 551 for such health benefit in Canada. Using a lower STL ratio (1.2) would improve the ICER to $7941/RRA.

Conclusions

Treatment of long lesions in small vessels with SES increases net healthcare costs. However, the ICER for SES compares favorably with the currently accepted comparator, i.e. BMS, to reduce coronary restenosis — at least for higher risk patients undergoing single-vessel revascularization.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

This study was supported by an unrestricted grant from Cordis Canada.

S Rinfret has received honoraria from Cordis Canada.

DJ Cohen has done consulting work for Medtronic Inc. and has received grants from Cordis Canada and Boston Scientific Inc.

E Schampaert has received honoraria from Cordis Canada and JJMP; a research grant from Cordis Canada for conducting the C-SIRIUS trial; and has a grant pending to conduct the coordination of COMBAT in Canada from Cordis Canada.

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Authors and Affiliations

  1. Pharmaco-Economics and Pharmaco-Epidemiology Unit, CHUM Research Center, Interventional Cardiology, CHUM-Notre Dame, East, Sherbrooke Street, Montreal, 1560, H2L 4M1, Canada

    Stéphane Rinfret, David J. Cohen & Amir A. Tahami Monfared

  2. Harvard Medical School, Harvard Clinical Research Institute, Boston, Massachusetts, USA

    Jacques LeLorier

  3. MédiaMed Technologies Inc., Montreal, Quebec, Canada

    Jean Mireault

  4. Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada

    Erick Schampaert

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  1. Stéphane Rinfret
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  2. David J. Cohen
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Correspondence to Stéphane Rinfret.

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Rinfret, S., Cohen, D.J., Tahami Monfared, A.A. et al. Cost Effectiveness of the Sirolimus-Eluting Stent in High-Risk Patients in Canada. Am J Cardiovasc Drugs 6, 159–168 (2006). https://doi.org/10.2165/00129784-200606030-00003

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