Cost-effectiveness of the Endeavor stent in de novo native coronary artery lesions updated with contemporary data.
OBJECTIVE
The Endeavor zotarolimus-eluting coronary stent has been shown to reduce the restenosis rate compared to bare metal stents and has impacted other clinical measures such as mortality, acute myocardial infarctions (AMI) and target vessel revascularisation (TVR).


RESULTS
Using pooled efficacy data from the Endeavor clinical trial programme, a model was developed to compare the cost effectiveness of the Endeavor drug eluting stent (DES) with the Driver bare meal stent (BMS) over a four year time period. Endeavor was more costly but had an improved clinical outcome compared to Driver BMS over four years with a 4% reduction in deaths, 33% reduction in AMI and a 45% reduction in TVR. Late stent thrombosis was the only event showing an increased incidence for Endeavor of 0.2% compared to 0% for Driver. The incremental cost effectiveness ratio was pound3,757/quality adjusted life years (QALY).


CONCLUSIONS
Although much controversy has surrounded the appropriate way to assess the cost effectiveness of DES technology, a comprehensive analysis is presented and this suggests that by using extended clinical trial data out to four years, the Endeavor DES in particular, but DES technologies in general, are cost-effective approaches to percutaneous coronary intervention.
United BioSource Corporation, London, United Kingdom.
Edit
E
Remak
Stephanie
S
Manson
John
J
Hutton
Pascale
P
Brasseur
Elaine
E
Olivier
Anthony
A
Gershlick
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000191:economics; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008670:Metals / Q000191:economics; D018803:Models, Economic; D009203:Myocardial Infarction / Q000191:economics / Q000209:etiology; D009313:National Health Programs / Q000191:economics; D011474:Prosthesis Design; D019057:Quality-Adjusted Life Years; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D015607:Stents / Q000191:economics*; D013927:Thrombosis / Q000191:economics / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
D002317:Cardiovascular Agents; D008670:Metals; C489443:zotarolimus; D020123:Sirolimus