Use of drug-eluting stents versus bare-metal stents in Korea: a cost-minimization analysis using population data.
OBJECTIVE
The goal of this study was to perform an economic analysis of a primary stenting with drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) admitted through an emergency room (ER) visit in Korea using population-based data.


METHODS
We employed a cost-minimization method using a decision analytic model with a two-year time period. Model probabilities and costs were obtained from a published systematic review and population-based data from which a retrospective database analysis of the national reimbursement database of Health Insurance Review and Assessment covering 2006 through 2010 was performed. Uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analyses.


RESULTS
Among 513 979 cases with AMI during 2007 and 2008, 24 742 cases underwent stenting procedures and 20 320 patients admitted through an ER visit with primary stenting were identified in the base model. The transition probabilities of DES-to-DES, DES-to-BMS, DES-to-coronary artery bypass graft, and DES-to-balloon were 59.7%, 0.6%, 4.3%, and 35.3%, respectively, among these patients. The average two-year costs of DES and BMS in 2011 Korean won were 11 065 528 won/person and 9 647 647 won/person, respectively. DES resulted in higher costs than BMS by 1 417 882 won/person. The model was highly sensitive to the probability and costs of having no revascularization.


CONCLUSIONS
Primary stenting with BMS for AMI with an ER visit was shown to be a cost-saving procedure compared with DES in Korea. Caution is needed when applying this finding to patients with a higher level of severity in health status.
National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
Hae Sun
HS
Suh
Hyun Jin
HJ
Song
Eun Jin
EJ
Jang
Jung-Sun
JS
Kim
Donghoon
D
Choi
Sang Moo
SM
Lee
D054855:Drug-Eluting Stents / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D056910:Republic of Korea; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*
D008670:Metals
Costs and cost analysis; Drug-eluting stents; Myocardial infarction; Pharmaceutical economics