[Economic evaluation and budget impact analysis of the Endeavor drug-eluting stent in Spain].
OBJECTIVE
Endeavor is a drug-eluting stent (DES) with superior results to the bare metal stent (BMS) and similar efficacy to other DES in terms of revascularization. The aim of this study was to assess the costs and benefits of Endeavor, other DES, BMS and coronary artery bypass grafts (CABG) in Spain.


METHODS
A Markov model with a 5-year time was used to reflect the management of patients with de novo coronary artery lesions in Spain. Model probabilities were derived from systematic reviews and randomized controlled trials of Endeavor. Health resources and costs were obtained from local data and were validated by experts. Effectiveness was measured as the number of revascularizations avoided, the major adverse coronary events (MACE) avoided and the quality adjusted life-years (QALYs) gained.


RESULTS
Endeavor had higher total costs than the BMS. The cost per revascularization avoided with Endeavor was 6,851 euro (at 1 year) and 10,831 euro (at 5 years). In terms of cost per MACE avoided with Endeavor, the results were 7,003 euro and 11,322 euro, respectively, and in terms of costs of QALY gained were 132,877 euro, 34,229 euro and 10,505 euro at 1, 2, and 5 years, respectively. The budget impact of the progressive introduction of Endeavor would be practically null, representing 0.4% of the total cost of percutaneous coronary interventions at 5 years.


CONCLUSIONS
The use of the Endeavor stent compared with BMS and CABG represents efficient resource use in patients with coronary artery disease, with cost-effectiveness results below the threshold of efficiency defined in Spain.
Moreu
José
J
Sección de Hemodinámica, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España.
Cequier
Angel
A
Brosa
Max
M
Rodríguez
José M
JM
Crespo
Carlos
C
Hernández
José M
JM
Vázquez
Nicolás
N
Fernández
Felipe
F
Ruiz-Nodar
Juan M
JM
Brasseur
Pascal
P
D002017:Budgets; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000191:economics / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D009203:Myocardial Infarction / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013030:Spain / Q000453:epidemiology
D002317:Cardiovascular Agents; C489443:zotarolimus; D020123:Sirolimus