Cost effectiveness of sirolimus-eluting stents compared with bare metal stents in acute myocardial infarction: insights from the TYPHOON trial.
BACKGROUND
Drug-eluting stents have been shown to reduce the rate of repeat revascularization after percutaneous coronary intervention for acute myocardial infarction (AMI) as compared with bare metal stents (BMS). A few studies have reported the cost effectiveness of sirolimus-eluting stents (SES) in several countries, but none in the particular setting of AMI in France.


OBJECTIVE
To assess the cost effectiveness of SES compared with BMS in a pre-specified subgroup of French patients with AMI in the randomized, multicentre TYPHOON trial.


METHODS
A prospective economic evaluation was conducted for the 337 patients in the TYPHOON trial who were enrolled in the French centres. In the TYPHOON trial, patients with AMI with ST-segment elevation less than 12 hours after the onset of chest pain were randomized to undergo percutaneous coronary intervention with either SES or BMS. Data on clinical outcomes and resource use were collected prospectively over a 1-year follow-up period (from October 2003 to October 2005). Unit costs were applied to the resource utilization data. The main outcome measure was the incremental cost-effectiveness ratio (ICER) for additional cost per target-vessel revascularization (TVR) avoided. The perspective of the study was the French healthcare system and costs were expressed in 2007 values.


RESULTS
SES significantly reduced the rate of TVR (6.6% vs 22.2% with BMS, p < 0.0001). There was no difference in the rate of death, recurrent myocardial infarction or stent thrombosis after 1 year of follow-up between the SES and BMS groups. Mean index admission costs, including the angioplasty procedure, were increased by 282 Euro per patient in the SES group, mostly driven by the price of the SES. Mean follow-up costs were 140 Euro per patient lower in the SES group. Mean aggregate 1-year costs showed a euro 1142 per-patient increase in the SES group compared with the BMS group. The ICER was 7321 Euro per TVR avoided.


CONCLUSIONS
In this pre-specified subgroup analysis of the TYPHOON trial, the use of SES in patients with AMI with ST-segment elevation less than 12 hours after the onset of chest pain reduced the rate of TVR compared with BMS. However, SES had a debatable ICER for the payer if it was based only on the specific benefit of TVR avoided.
Canoui-Poitrine
Florence
F
Assistance Publique - Hopitaux de Paris (AP-HP), Henri Mondor Hospital, EA 4393, Paris 12 Medical School, Créteil, France.
Jeanblanc
Grégoire
G
Alberti
Corinne
C
Armoogum
Priscilla
P
Cebrian
Ana
A
Carrié
Didier
D
Henry
Patrick
P
Teiger
Emmanuel
E
Slama
Michel
M
Spaulding
Christian
C
Durand-Zaleski
Isabelle
I
D016009:Chi-Square Distribution; D023903:Coronary Restenosis / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D005602:France; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D008670:Metals; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage / Q000191:economics; D018709:Statistics, Nonparametric
D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus