Cost-Effectiveness of Palmaz-Schatzª Stenting in Patients with Coronary Artery Disease in The Netherlands.
The increasing use of stent implantation in coronary artery disease raises economic concerns for health care decision-makers. This model analysis, applying to the Dutch health care system and using the latest clinical and economic data, demonstrates coronary stent implantation (CSI) in single-vessel disease (SVD) to be clinically and economically superior to conventional balloon angioplasty (PTCA). Although the procedural cost for CSI remains over NLG 3,300 higher than for PTCA (NLG 8,871 vs. NLG 5,510), this cost difference in the cath lab is decreased to approximately NLG 2,200 during the in-hospital period due to avoided procedural complications and associated bail-out treatments. By the end of year one, the incremental cost of CSI is virtually recouped (by over 90%) through savings in revascularization procedures, and this result is maintained over subsequent years. Combined with a higher rate of event-free patients, this virtual cost-equality improves the cost-effectiveness of CSI, which has a 27.8%, 29.4%, and 31.5% lower cost per event-free survivor than PTCA at the 1-, 2-, and 3-year follow-ups, respectively. In multi-vessel disease, CSI also appears to be a cost-effective alternative to CABG.
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HealthEcon Ltd., P.O. Box 1510, 4001 Basle, Switzerland. dschwicker@healthecon.com
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