Cost-effectiveness of sirolimus-eluting stents for treatment of complex coronary stenoses: results from the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) trial.
BACKGROUND
Recently, sirolimus-eluting stents (SESs) have been shown to dramatically reduce the risk of angiographic and clinical restenosis compared with bare metal stent (BMS) implantation. However, the overall cost-effectiveness of this strategy is unknown.


RESULTS
Between February and August 2001, 1058 patients with complex coronary stenoses were enrolled in the SIRIUS trial and randomized to percutaneous coronary revascularization with either a SES or BMS. Clinical outcomes, resource use, and costs were assessed prospectively for all patients over a 1-year follow-up period. Initial hospital costs were increased by 2881 dollars per patient with SESs. Over the 1-year follow-up period, use of SESs led to substantial reductions in the need for repeat revascularization, including repeat percutaneous coronary intervention and bypass surgery. Although follow-up costs were reduced by 2571 dollars per patient with SESs, aggregate 1-year costs remained 309 dollars per patient higher. The incremental cost-effectiveness ratio for SES was 1650 dollars per repeat revascularization event avoided or 27,540 dollars per quality-adjusted year of life gained, values that compare reasonably with other accepted medical interventions. Under updated treatment assumptions regarding available stent lengths and duration of antiplatelet therapy, use of SESs was projected to reduce total 1-year costs compared with BMSs.


CONCLUSIONS
Although use of SESs was not cost-saving compared with BMS implantation, for patients undergoing percutaneous coronary intervention of complex coronary stenoses, their use appears to be reasonably cost-effective within the context of the US healthcare system.
Cohen
David J
DJ
Harvard Clinical Research Institute, Boston, Mass, USA. dcohen@caregroup.harvard.edu
Bakhai
Ameet
A
Shi
Chunxue
C
Githiora
Louise
L
Lavelle
Tara
T
Berezin
Ronna H
RH
Leon
Martin B
MB
Moses
Jeffrey W
JW
Carrozza
Joseph P
JP
Zidar
James P
JP
Kuntz
Richard E
RE
D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D006328:Cardiac Catheterization / Q000191:economics; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000453:epidemiology; D004311:Double-Blind Method; D016527:Drug Costs; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000191:economics / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D020123:Sirolimus / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D015607:Stents / Q000191:economics*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D020123:Sirolimus