title: The favorable price evolution between bare metal stents and drug eluting stents increases the cost effectiveness of drug eluting stents.
abstract: OBJECTIVE
  We aimed to assess the cost effectiveness of the sirolimus-eluting stent (SES) in diabetic and non-diabetic patients vs. bare metal stents (BMS).
  
  
  METHODS
  EVASTENT was a matched cohort registry of patients undergoing revascularization exclusively with SES; for each diabetic patient (db+) included, stratified according to single (SVD) or multiple (MVD) vessel disease, a non-diabetic patient (db-) was subsequently included. Efficacy, safety and cost data were obtained from the SES database, and then data from the BMS group were derived by using an original method of transition probabilities of events (Markov model and Monte Carlo simulations) if BMS had been implanted in the same patient, over a 3-year time period. Sensitivity analysis was performed by varying the price difference between BMS and SES from 2008 to 2012.
  
  
  RESULTS
  In this study, 1731 patients were included with 97% complete follow-up at 3-years. In 2008, compared to BMS the SES was cost effective only in MVD db+ (7494€ per avoided revascularization (PAR) vs. >10,000€ in other groups). In 2012, after a reduction in the price difference between SES and BMS, SES were cost effective in MVD db+ (-891), SVD db+ (3519), MVD db- (3050), and SVD db- (6329) patients. Otherwise, the cardiovascular mortality rate was higher (p<0.0001) in MVD db+ than in SVD db+, MVD db- and SVD db-.
  
  
  CONCLUSIONS
  The SES is now cost effective in diabetic and non-diabetic patients, after a favorable price evolution between drug eluting and bare metal stents.
authors: Cardiology Department, Grenoble University Hospital, France; INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France. Electronic address: GBarone@chu-grenoble.fr.
authors: Gilles
authors: G
authors: Barone-Rochette
authors: Jacques
authors: J
authors: Machecourt
authors: Gerald
authors: G
authors: Vanzetto
authors: Alison
authors: A
authors: Foote
authors: Jean-Louis
authors: JL
authors: Quesada
authors: Christel
authors: C
authors: Castelli
authors: Nicolas
authors: N
authors: Danchin
authors: Christophe
authors: C
authors: Combescure
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods / Q000639:trends; D054855:Drug-Eluting Stents / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals / Q000191:economics*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000191:economics* / Q000639:trends; D012042:Registries; D012307:Risk Factors; D015607:Stents / Q000191:economics / Q000639:trends
chemical_list: D008670:Metals
keywords: Cost-effectiveness analysis; Diabetes; Drug-eluting stent