The costs and quality-of-life outcomes of drug-eluting coronary stents: a systematic review.
OBJECTIVE
While the efficacy of drug-eluting coronary stents (DES) has been demonstrated by several clinical trials, the impact of DES on health-care costs and recipient quality of life (QOL) is controversial. We performed a systematic review of the published literature on DES costs and the QOL effects of restenosis and target vessel revascularization (TVR).


METHODS
Among 536 potential articles initially identified by a broad search, 12 publications ultimately met inclusion criteria. Data were independently abstracted, evaluated for quality and relevance, and summarized by two reviewers. Excessive heterogeneity among these studies prevented formal meta-analysis, thus a narrative synthesis of the literature was performed.


RESULTS
In four economic studies, DES recipients had 1,600 dollars-3,200 dollars higher up-front costs than recipients of bare metal stents, but the differences in total costs after 1 year were less pronounced (200 dollars-1,200 dollars), and estimates of the average cost of an avoided revascularization ranged widely (1,800 dollars-36,900 dollars). All eight QOL studies indicated that restenosis was associated with lower QOL, but only two studies quantified this in terms of quality-adjusted life years (QALYs), with estimates ranging from 0.06 to 0.08. An additional study estimated that the median willingness to pay to prevent restenosis was 2,400 dollars-3,600 dollars.


CONCLUSIONS
There is a lack of convergence in the literature on the cost of DES in avoiding TVR. There is more agreement that the average QALY benefit of an avoided revascularization is 0.04-0.08. This implies that use of DES in patients where the average cost per avoided revascularization exceeds 8,000 dollars may be less likely to be cost-effective.
Groeneveld
Peter W
PW
Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. peter.groeneveld@va.gov
Suh
Janice J
JJ
Matta
Mary Anne
MA
D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D015607:Stents / Q000191:economics; D014481:United States