Cost-effectiveness of sirolimus-eluting stents compared with vascular brachytherapy for the treatment of in-stent restenosis.
BACKGROUND
Sirolimus-eluting stents (SESs) were recently shown to be superior to vascular brachytherapy for the treatment of restenosis within a bare metal stent. No economic comparison of these alternative strategies has yet been reported.


METHODS
We conducted a prospective health economic study involving all patients randomized to SES (n = 259) or brachytherapy (n = 125) in the SISR trial. Procedural, hospital, and outpatient costs, as well as physician fees, were estimated through 12 months based on measured resource use and itemized hospital bills. Cost-effectiveness was assessed in terms of the cost per repeat revascularization avoided, cost per major adverse cardiac event avoided, and cost per event-free patient.


RESULTS
Although initial device costs were approximately $1100/patient higher in the SES group, this was offset by higher physician fees associated with brachytherapy, such that initial hospitalization costs were similar for the 2 groups. Because SES significantly reduced repeat revascularization procedures and major adverse cardiac event compared with brachytherapy during follow-up, cumulative 12-month costs were significantly lower in the SES group ($16,482 vs $19,435, mean difference -$2953, 95% CI -$5470 to -$792). Sirolimus-eluting stenting was thus both more effective and less expensive than brachytherapy, as confirmed in >98% of bootstrap replications for each of the cost-effectiveness outcomes.


CONCLUSIONS
Compared with vascular brachytherapy, SES is an economically dominant strategy for the treatment of in-stent restenosis.
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Matthew R
MR
Reynolds
Duane S
DS
Pinto
Chunxue
C
Shi
Joshua
J
Walczak
Ronna
R
Berezin
David R
DR
Holmes
David J
DJ
Cohen
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001918:Brachytherapy / Q000191:economics*; D006328:Cardiac Catheterization / Q000191:economics; D023903:Coronary Restenosis / Q000532:radiotherapy / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage* / Q000191:economics
D020123:Sirolimus