Economic analysis of the use of drug-eluting stents from the perspective of Belgian health care.
OBJECTIVE
Recent evidence shows that drug-eluting stent devices (DES) substantially reduce the risk of in-stent restenosis compared with classic bare metal stent devices (BMS). In Belgium, however, the use of BMS is still standard procedure due to the higher prices of the newer DES. Although the use of DES is more expensive in the short term it might be beneficial in the long term due to the avoidance of revascularization costs. The primary objective of this study is to compare the net cost of DES and BMS from the perspective of Belgian health care.


RESULTS
Cost differences between DES and BMS are determined by the difference in stent price and the difference in the rate of re-intervention. The cost of revascularization of patients with in-stent restenosis was estimated based on data gathered at the Antwerp University hospital (UZA). Data on effectiveness were obtained from a literature meta-analysis. Because of some important study limitations, a sensitivity analysis was included in this study. In general, the use of DES was cost saving as compared with BMS, with savings amounting to E 165 for Cypher stent devices and Euro 128 for Taxus stent devices in the base case scenario. For patients with a high risk of restenosis net savings persist in almost all sensitivity analyses.


CONCLUSIONS
The use of DES in patients with a high in-stent restenosis risk is cost saving. Price evolutions in the stent device market predict that the use of DES, if not yet cost saving, will become cost saving in the near future for all types of patients. Recent evidence, however, casts some doubt on the long-term effectiveness of DES.
Mahieu
Joris
J
Faculty of Applied Economics of the University of Antwerp, Belgium. joris_mahieu@hotmail.com
De Ridder
Annemieke
A
De Graeve
Diana
D
Vrints
Chris
C
Bosmans
Johan
J
D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D001530:Belgium; D001026:Coronary Artery Bypass / Q000191:economics; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000191:economics*; D005500:Follow-Up Studies; D006801:Humans; D008670:Metals / Q000009:adverse effects / Q000191:economics; D017239:Paclitaxel / Q000191:economics / Q000627:therapeutic use; D011474:Prosthesis Design / Q000191:economics; D012086:Reoperation / Q000191:economics; D012107:Research Design; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020123:Sirolimus / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome