title: Comparison of cost-effectiveness of oral rapamycin plus bare-metal stents versus first generation of drug-eluting stents (from the Randomized Oral Rapamycin in Argentina [ORAR] 3 trial).
abstract: The aim of this study was to compare 5-year cost-effectiveness and clinical outcomes of patients with oral rapamycin (OR) plus bare-metal stent versus the drug-eluting stent (DES) strategy. During 2006 to 2007, a total of 200 patients were randomized to OR (n = 100) and DES (n = 100). Primary end point was to compare costs of initial procedure and cost-effectiveness of both revascularization strategies. Safety was evaluated by the composite of death, myocardial infarction, and cerebrovascular accident. Efficacy was assessed by target vessel and target lesion revascularizations. The 2 groups had similar baseline demographic, clinical, and angiographic characteristics. In the DES group, paclitaxel-, zotarolimus-, and sirolimus-eluting stents were used. Five-year clinical follow-up was accomplished in 99% patients. The DES group had significantly higher procedural (p <0.001), discharge to first-year (p = 0.02), and 1- to 5-year costs (p <0.001) compared with the OR group. At 5 years, the composite end point of death, myocardial infarction, and cerebrovascular accident (12% in the OR group vs 25% in the DES group, p = 0.01) was significantly less in the OR group. Target vessel revascularization (14.5% in the OR group vs 21% in the DES group, p = 0.16) and target lesion revascularization (10% in the OR group vs 17.6% in the DES group, p = 0.05) were not significantly different. In conclusion, a strategy of OR plus bare-metal stent was cost saving than a first-generation DES.
authors: Centro de Estudios en Cardiología Intervencionista, Buenos Aires, Argentina; Department of Cardiology, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina; Department of Cardiology, Sanatorio Las Lomas, Buenos Aires, Argentina. Electronic address: rodrigueza@sanatorio-otamendi.co.
authors: Alfredo E
authors: AE
authors: Rodriguez
authors: Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Igor
authors: I
authors: Palacios
authors: Centro de Estudios en Cardiología Intervencionista, Buenos Aires, Argentina.
authors: Alfredo M
authors: AM
authors: Rodriguez-Granillo
authors: Department of Cardiology, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina; Department of Cardiology, Sanatorio Las Lomas, Buenos Aires, Argentina.
authors: Juan R
authors: JR
authors: Mieres
authors: Director, Argentina Association in Health and Economics, Buenos Aires, Argentina.
authors: Sonia
authors: S
authors: Tarragona
authors: Department of Cardiology, Clínica IMA, Buenos Aires, Argentina.
authors: Carlos
authors: C
authors: Fernandez-Pereira
authors: Department of Cardiology, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina; Department of Cardiology, Clínica IMA, Buenos Aires, Argentina.
authors: Leonardo
authors: L
authors: Solorzano
authors: Department of Cardiology, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina; Department of Cardiology, Sanatorio Las Lomas, Buenos Aires, Argentina.
authors: Ricardo
authors: R
authors: Pauletto
authors: Department of Cardiology, Erasmus Thoraxcenter, Rotterdam, The Netherlands.
authors: Patrick W
authors: PW
authors: Serruys
authors: Department of Cardiology, Careggi Hospital, Florence, Italy.
authors: David
authors: D
authors: Antoniucci
mesh_terms: D000284:Administration, Oral; D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics*; D015607:Stents / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus