[Antiproliferative drug-eluting stents: systematic review of the benefits and estimate of economic impact].
OBJECTIVE
Antiproliferative drug-coated stents are a possible solution for post-angioplasty coronary restenosis. Here we analyze their efficacy, effectiveness and safety, and estimate the economic impact of their use in Spain.


METHODS
Systematic review (meta-analysis) of the scientific evidence available up to January 2004, and analysis of hospital costs within a 1-year time horizon.


RESULTS
We identified 12 published studies (5 clinical series and 7 RCTs) comparing coated stents (sirolimus or paclitaxel) with conventional stents in patient with de novo single lesions < 30 mm in 2.5-3.5 mm vessels. In nearly all cases the rates of angiographic restenosis and major adverse cardiac events were lower in the coated stent group after 6-12 months. Meta-analysis showed a 69% decrease in revascularization rate (RR=0.31; 95%CI, 0.19-0.51). For every 1000 patients with de novo lesions, the use of a coated stent involved an additional average cost of Euro 818718. The estimated neutral price of a new stent was Euro 1448 at a market price per unit of Euro 2000.


CONCLUSIONS
At 12-month follow-up, sirolimus- or paclitaxel-eluting stents were effective and safe in patients with de novo lesions and low or medium risk of restenosis. At current market prices, the widespread use of these stents would involve an increase in health care expenditure for the different sensitivity scenarios we evaluated. More studies are needed to specify the type of patients and lesions likely to obtain the greatest clinical benefit.
Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Servei Català de la Salut (CatSalut), Departament de Sanitat i Seguretat Social, Barcelona, Spain. goliva@aatrm.catsalut.net
Gloria
G
Oliva
Mireia
M
Espallargues
Juan M V
JM
Pons
D015906:Angioplasty, Balloon, Coronary; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems / Q000191:economics / Q000295:instrumentation*; D004343:Drug Implants / Q000191:economics; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage; D013030:Spain; D015607:Stents / Q000191:economics
D004343:Drug Implants; D017239:Paclitaxel; D020123:Sirolimus