title: Cost effectiveness of drug-eluting stents in acute myocardial infarction patients in Germany: results from administrative data using a propensity score-matching approach.
abstract: BACKGROUND
  The high number of patients with acute myocardial infarction (AMI) has facilitated greater research, resulting in the development of innovative medical devices. So far, results from economic evaluations that compared drug-eluting stents (DES) and bare-metal stents (BMS) have not shown clear evidence that one intervention is more cost effective than the other.
  
  
  OBJECTIVE
  The aim of this study was to measure the cost effectiveness of DES compared with BMS in routine care.
  
  
  METHODS
  We used administrative data from a large German sickness fund to compare the costs and effectiveness of DES and BMS in patients with AMI. Patients with hospital admission after AMI in 2004 and 2005 were followed up for 1 year after hospital discharge. The cost of treatment and survival after 365 days were compared for patients treated with DES and BMS. We adjusted for covariates defined according to the Ontario Acute Myocardial Infarction Mortality Prediction Rules using propensity score matching. After matching, we calculated incremental cost-effectiveness ratios (ICERs) by (i) using sample means based on bootstrapping procedures and (ii) estimating generalized linear mixed models for costs and survival.
  
  
  RESULTS
  After propensity score matching, the sample included 719 patients treated with DES and 719 patients treated with BMS. A comparison of sample means resulted in average costs of € 12 714 and € 11 714 for DES and BMS, respectively, in 2005 German euros. Difference in 365-day survival was not statistically significant (700 patients with DES and 701 with BMS). The ICER of DES versus BMS was -€ 718 709 per life saved. Bootstrapping resulted in DES being dominated by BMS in 54.5% of replications and DES being a dominant strategy in 2.7% of replications. Results from regression models and sensitivity analyses confirm these results.
  
  
  CONCLUSIONS
  Treatment with DES after admission with AMI is less cost effective than treatment with BMS. Our results are in line with other cost-effectiveness analyses that used administrative data, i.e. under routine care conditions. However, our results do not preclude that DES may be cost effective in specific patient subgroups.
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany. michael.baeumler@tu-berlin.de
authors.forename: Michael
authors.initials: M
authors.lastname: Bäumler
authors.forename: Tom
authors.initials: T
authors.lastname: Stargardt
authors.forename: Jonas
authors.initials: J
authors.lastname: Schreyögg
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D012044:Regression Analysis; D015607:Stents / Q000191:economics; D016019:Survival Analysis