Economic evaluation of drug-eluting stents in coronary angioplasty.
Coronary angioplasty has revolutionized the treatment of coronary artery disease, from the first balloon angioplasty to the current era of drug-eluting stents (DES), which were developed to eliminate the bare metal stent's (BMS) Achilles' heel, restenosis. DES have an extremely low restenosis rate but are significantly more expensive and need more prolonged dual antiplatelet therapy. Restenosis has a generally benign prognosis and is not associated with higher mortality or major adverse cardiovascular events, which has limited the penetration of DES, whose only advantage is the reduction of restenosis. Economic evaluation of DES is therefore of paramount importance for assessing their appropriate use. In randomized trials in which they are compared with BMS, economic evaluation is advantageous for DES, with good cost-effectiveness ratios for both cost per quality-adjusted life year (QALY) and cost per revascularization avoided. However, these trials have two major limitations--the angiographic follow-up protocol and selection of patients with lower risk--and so their results do not accurately reflect reality. Other studies with unselected populations and cost-effectiveness models show that there is an economic advantage in the use of DES in groups with higher risk of restenosis, but not for the whole population undergoing angioplasty. Use of DES will be more appropriate if we can identify populations with a higher likelihood of restenosis, because these are the patients that will benefit most from their use and in whom they will be economically advantageous.
Santos
Ricardo
R
Serviço de Cardiologia e Laboratório de Hemodinâmica e Intervenção Coronária dos Hospital de São Bernardo, SA, Setúbal, Portugal. ric.santos@netcabo.pt
Pereira
Hélder
H
D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems / Q000191:economics*; D006801:Humans; D015607:Stents / Q000191:economics*