title: Clinical, humanistic, and economic outcomes between drug-eluting stent (DES) and bare metal stent (BMS): 18-month follow-up study.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is one of the most performed interventions for ischemic heart diseases. In Hong Kong, the total number of patient discharges and deaths for ischemic heart diseases in 2009 was 33,363, including 4,360 deaths. There are over 5,000 cases of PCI yearly. This study aimed to compare clinical, economic, and humanistic outcomes among patients receiving drug-eluting stent (DES) or bare metal stent (BMS) in Hong Kong.
  
  
  METHODS
  Patients who received stent implantation between September 15, 2009 and October 11, 2010 in Prince of Wales Hospital, Hong Kong, were recruited and followed for 18 months. Occurrence of major adverse cardiac events (cardiac death, non-fatal MI, TLR and TVR) was employed as the clinical outcome measurements. Improvement in quality-of-life by stent interventions was measured as quality-adjusted life-year (QALY). EQ-5D questionnaire was adopted to assess the QALY gained. Cost-utility analysis and cost-effectiveness analysis for BMS and DES were employed as the economic outcome measurement.
  
  
  RESULTS
  Six hundred and eighty-four patients (DES = 402; BMS = 282) were included. From 0-18 months, TLR rate (2.7% vs 3.5%, p = .549) and TVR rate (3.7% vs 6.4%, p = .111) were lower in the DES group, but without statistical significance. EQ VAS (71.06 ± 14.56 vs 71.07 ± 16.57, p = .998) and utility score (0.81 ± 0.17 vs 0.78 ± 0.16, p = .162) were comparable between DES and BMS group. Overall, the cost per QALY gained was HKD + 1,178,100 and ICER was HKD + 187,000 (1USD = 7.8 HKD).
  
  
  CONCLUSIONS
  No significant difference in TVR, TLR rates, EQ VAS, and utility score was found between the DES and BMS group. The higher cost of index procedure for the DES group was found to be partly offset by reduced cost of follow-up, offering cost-effectiveness in ACS patients, predominantly in STEMI patients. DES was recommended for STEMI patients.
authors.affiliation: a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PR China.
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Lee
authors.affiliation: a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PR China.
authors.forename: Franco W
authors.initials: FW
authors.lastname: Cheng
authors.affiliation: a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PR China.
authors.forename: Adrian Y
authors.initials: AY
authors.lastname: Choi
authors.affiliation: a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PR China.
authors.forename: Sam T
authors.initials: ST
authors.lastname: Fong
authors.affiliation: b Department of Medicine and Therapeutics, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PR China.
authors.forename: Cheuk Man
authors.initials: CM
authors.lastname: Yu
authors.affiliation: b Department of Medicine and Therapeutics, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PR China.
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents / Q000145:classification / Q000191:economics*
keywords: Coronary heart disease; bare metal stent; drug eluting stent; major adverse cardiac event; percutaneous coronary intervention