title: Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease.
abstract: The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.
authors.affiliation: Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland.
authors.forename: Ariel
authors.initials: A
authors.lastname: Beresniak
authors.affiliation: Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Caruba
authors.affiliation: Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sabatier
authors.affiliation: Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
authors.affiliation: Ariel Beresniak, Data Mining International, Research and Development, CH-1215 Geneva, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
keywords: Coronary artery disease; Cost-effectiveness; Drug eluting stent; Percutaneous coronary