title: New Perspectives on the Cost-Effectiveness of Palmaz-Schatzª Coronary Stenting, Balloon Angioplasty, and Coronary Artery Bypass Surgery Ñ A Decision Model Analysis.
abstract: We developed an outcomes model to compare both the clinical effects and cost-effectiveness of the following strategies for treating patients with single (SVD) and multi-vessel (MVD) coronary artery disease: coronary stent implantation (CSI), balloon angioplasty (PTCA), and coronary artery bypass surgery (CABG). These analyses have been carried out in five European countries: France, Germany, Italy, The Netherlands, and Spain, accounting for approximately 75% of revascularization procedures performed in Europe. This paper describes the methodology, details the model, discusses input data, and reports on clinical outcomes. Country-specific data and findings are reported in five ÒsatelliteÓ papers to this communication. The clinical outcomes predicted in our model are different from those of earlier studies in that we have found stenting to be clinically more superior to PTCA in terms of improving event-free survival than previously reported in SVD (89% vs. 75% at 1 year; 82% vs. 68% at 3 years). This is due to the clinical input data and expert estimates used, which consider the most recent advances in stent technology: heparin-coated stents, high-pressure post-stent dilatation, the replacement of anticoagulation with antiplatelet therapy, and a shortened length of hospital stay due to reduced complications. In MVD, CABG is the superior treatment strategy, with a predicted event-free survival of 90% at 3-years. MVD stenting is predicted to markedly improve patient outcomes as compared to PTCA, and is not far behind CABG (76% at 3 years).
authors.affiliation: HealthEcon Ltd., P.O. Box 1510, 4001 Basle, Switzerland. dschwicker@healthecon.com
authors.initials: D
authors.lastname: Schwicker
authors.initials: K
authors.lastname: Banz