title: Analysis of the cost-effectiveness of drug-eluting and bare-metal stents in coronary disease.
abstract: 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.
authors: Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ - Brazil. ef.cardiol@terra.com.br
authors: Esmeralci
authors: E
authors: Ferreira
authors: Denizar Vianna
authors: DV
authors: Araújo
authors: Vitor Manuel Pereira
authors: VM
authors: Azevedo
authors: Cyro Vargues
authors: CV
authors: Rodrigues
authors: Alcides
authors: A
authors: Ferreira
authors: Camillo de Lellis
authors: Cde L
authors: Junqueira
authors: José Geraldo de Castro
authors: JG
authors: Amino
authors: Mara Lucia
authors: ML
authors: Farias
authors: Antonio
authors: A
authors: Farias Neto
authors: Denilson Campos
authors: DC
authors: de Albuquerque
mesh_terms: 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