One year cost effectiveness of sirolimus eluting stents compared with bare metal stents in the treatment of single native de novo coronary lesions: an analysis from the RAVEL trial.
OBJECTIVE
To assess the balance between costs and effects of the sirolimus eluting stent in the treatment of single native de novo coronary lesions in the RAVEL (randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions) study.


METHODS
Multicentre, double blind, randomised trial.


METHODS
Percutaneous coronary intervention for single de novo coronary lesions.


METHODS
238 patients with stable or unstable angina.


METHODS
Randomisation to sirolimus eluting stent or bare stent implantation.


METHODS
Patients were followed up to one year and the treatment effects were expressed as one year survival free of major adverse cardiac events (MACE). Costs were estimated as the product of resource utilisation and Dutch unit costs.


RESULTS
At one year, the absolute difference in MACE-free survival was 23% in favour of the sirolimus eluting stent group. At the index procedure, sirolimus eluting stent implantation had an estimated additional procedural cost of 1286. At one year, however, the estimated additional cost difference had decreased to 54 because of the reduction in the need for repeat revascularisations in the sirolimus group (0.8% v 23.6%; p < 0.01). After adjustment of actual results for the consequences of angiographic follow up (correction based on data from the BENESTENT (Belgium Netherlands stent) II study), the difference in MACE-free survival was estimated at 11.1% and the additional one year costs at 166.


CONCLUSIONS
The one year data from RAVEL suggest an attractive balance between costs and effects for sirolimus eluting stents in the treatment of single native de novo coronary lesions. The cost effectiveness of drug eluting stents in more complex lesion subsets remains to be determined.
van Hout
B A
BA
Universitair Medisch Centrum, Julius Centrum, Utrecht, The Netherlands.
Serruys
P W
PW
Lemos
P A
PA
van den Brand
M J B M
MJ
van Es
G-A
GA
Lindeboom
W K
WK
Morice
M-C
MC
D017023:Coronary Angiography / Q000191:economics; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000191:economics / Q000517:prevention & control; D023921:Coronary Stenosis / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008670:Metals; D009426:Netherlands; D020123:Sirolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D015607:Stents / Q000191:economics*; D013499:Surface Properties
D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus