Analysis of the cost-effectiveness of drug-eluting and bare-metal stents in coronary disease.
BACKGROUND
There is a scarcity of cost-effectiveness analyses in the national literature comparing drug-eluting stents (DES) with bare-metal stents (BMS), at late follow-up.


OBJECTIVE
To estimate the Incremental Cost-Effectiveness Ratio (ICER) between DES and BMS in uniarterial coronariopathy.


METHODS
217 patients (130 DES and 87 BMS), with 48 months of follow-up (mean = 26 months) were assessed.


METHODS
cost per prevented restenosis, with effectiveness being defined as the decrease in major events. The analytical model of decision was based on the study by Polanczyk et al. The direct costs were those used directly in the interventions.


RESULTS
The sample was homogenous for age and sex. The DES was more used in diabetic patients: 59 (45.4%) vs 16 (18.4%)(p<0.0001) and with a history of coronary artery disease (CAD): 53 (40.7%) vs 13 (14.9%)(p<0.0001). The BMS was more used in simple lesions, but with worse ventricular function. The DES were implanted preferentially in proximal lesions: (p=0.0428) and the BMS in the mid-third (p=0.0001). Event-free survival: DES = 118 (90.8%) vs BMS=74 (85.0%) (p=0.19); Angina: DES=9 (6.9%) vs BMS=9 (10.3%) (NS): Clinical restenosis: DES=3 (2.3%) vs BMS=10 (10.3%) (p=0.0253). Cardiac deaths: 2 (1.5%) in DES and 3 (3.5%) in BMS (NS).


RESULTS
the tree of decision was modeled based on restenosis. The net benefit for the DES needed an increment of R$7,238.16. The ICER was R$131,647.84 per prevented restenosis (above the WHO threshold).


CONCLUSIONS
The DES was used in more complex lesions. The clinical results were similar. The restenosis rate was higher in the BMS group. The DES was a non-cost-effective strategy.
Ferreira
Esmeralci
E
Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ - Brazil. ef.cardiol@terra.com.br
Araújo
Denizar Vianna
DV
Azevedo
Vitor Manuel Pereira
VM
Rodrigues
Cyro Vargues
CV
Ferreira
Alcides
A
Junqueira
Camillo de Lellis
Cde L
Amino
José Geraldo de Castro
JG
Farias
Mara Lucia
ML
Farias Neto
Antonio
A
de Albuquerque
Denilson Campos
DC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000628:therapy*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000191:economics*; D015981:Epidemiologic Factors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D016276:Ventricular Function