Clinical and economic outcomes after introduction of drug-eluting stents.
BACKGROUND
In clinical trials, drug-eluting stents (DES) improve clinical outcomes but are more expensive than bare-metal stents (BMS).


OBJECTIVE
To assess clinical and economic outcomes of all percutaneous coronary intervention (PCI) procedures in a general interventional cardiology practice before and after DES introduction in 2003.


METHODS
We identified all patients undergoing PCI in 2000-2002 (early cohort, pre-DES era) and from 2004 through April 31, 2006 (late cohort, DES era) in a large PCI registry. Logistic and Cox proportional hazard models estimated the risk of adverse events; generalized linear modeling predicted economic outcomes.


RESULTS
We compared 4303 early-cohort patients with 3422 late-cohort patients. Most early-cohort patients (90%) had BMS implanted; the rest had atherectomy or balloon angioplasty only. Among late-cohort patients, 83% had DES, 14% BMS, and 6% balloon angioplasty or atherectomy only. In-hospital adverse-event rates and incidence of death or myocardial infarction (during a median follow-up of 22 months) were similar. Follow-up procedures were significantly fewer in the later era (hazard ratio for target lesion revascularization: 0.58; 95% confidence interval [CI], 0.50-0.68). Although catheterization lab supply costs were higher in the DES era, length of stay following index PCI and overall practice costs were reduced, on average, 0.40 days and $2053 in the late cohort (95% bootstrapped CI of adjusted mean difference, -$2937 to -$1197). Follow-up cardiac hospitalization costs were similar at 1 year.


CONCLUSIONS
Patients undergoing PCI following DES introduction experienced improved clinical outcomes during follow-up and reduced overall procedural costs, despite higher stent acquisition costs.
Rihal
Charanjit S
CS
Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. rihal@mayo.edu
Ryan
James L
JL
Singh
Mandeep
M
Lennon
Ryan J
RJ
Bresnahan
John F
JF
Liesinger
Juliette T
JT
Gersh
Bernard J
BJ
Ting
Henry H
HH
Holmes
David R
DR
Long
Kirsten Hall
KH
D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000706:statistics & numerical data; D015331:Cohort Studies; D016001:Confidence Intervals; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D054855:Drug-Eluting Stents / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D018803:Models, Economic; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States