title: Contemporary Context of Drug-Eluting Stents in Brazil: A Cost Utility Study.
abstract: Although drug-eluting stents (DES) have been widely incorporated into clinical practice in developed countries, several countries restrict their use mainly because of their high cost and unfavorable incremental cost-effectiveness ratios (ICER).
  
  
  
  To evaluate the cost-effectiveness of DES in comparison with bare-metal stents (BMS) for treatment of coronary artery disease (CAD).
  
  
  
  Markov model.
  
  
  
  Published literature, government database, and CAD patient cohort.
  
  
  
  Single-vessel CAD patients.
  
  
  
  One year and lifetime.
  
  
  
  Brazilian Public Health System (SUS).
  
  
  
  Six strategies composed of percutaneous intervention with a BMS or 1 of 5 DES (paclitaxel, sirolimus, everolimus, zotarolimus, and zotarolimus resolute).
  
  
  
  Cost for target vessel revascularization avoided and cost for quality-adjusted life year gained.
  
  
  
  In the short-term analysis, sirolimus was the most effective and least costly among DES (ICER of I$20,642 per target vessel revascularization avoided), with all others DES dominated by sirolimus. Lifetime cumulative costs ranged from I$18,765 to I$21,400. In the base case analysis, zotarolimus resolute had the most favorable ICER among the DES (ICER I$62,761), with sirolimus, paclitaxel, and zotarolimus being absolute dominated and everolimus extended dominated by zotarolimus resolute, although all the results were above the willingness-to-pay threshold of 3 times the gross domestic product per capita (I$35,307).
  
  
  
  In deterministic sensitivity analysis, results were sensitive to cost of DES, number of stents used per patient, baseline probability, and duration of stent thrombosis risk. The probabilistic sensitivity analysis demonstrated a probability of 81% for BMS being the strategy of choice, with 9% for everolimus and 9% zotarolimus resolute, at the willingness-to-pay threshold.
  
  
  
  DES is not a good value for money in SUS perspective, despite its benefit in reducing target vessel revascularization. Since the cost-effectiveness of DES is mainly driven by the stents' cost difference, they should cost less than twice the BMS price to become a cost-effective alternative.
authors.affiliation: Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (SFS, EGB, CAP)|National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq, Brazil (SFS, EGB, CAP)
authors.forename: Steffan Frosi
authors.initials: SF
authors.lastname: Stella
authors.affiliation: Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (SFS, EGB, CAP)|National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq, Brazil (SFS, EGB, CAP)|Department of Internal Medicine, School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil (EGB)
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gehling Bertoldi
authors.affiliation: Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (SFS, EGB, CAP)|National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq, Brazil (SFS, EGB, CAP)|Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (CAP)|Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (CAP)
authors.forename: Carísi Anne
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D001938:Brazil; D003324:Coronary Artery Disease / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D054855:Drug-Eluting Stents / Q000191:economics*; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D017059:Models, Econometric; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D015607:Stents / Q000191:economics
chemical_list: D007166:Immunosuppressive Agents
keywords: bare-metal stent; coronary artery disease; cost-effectiveness; drug-eluting stent