A systematic review and economic analysis of drug-eluting coronary stents available in Australia

Lord, Sarah J., Howard, Kirsten, Allen, Felicity, Marinovich, Luke, Burgess, David C, King, Richard and Atherton, John J. (2005) A systematic review and economic analysis of drug-eluting coronary stents available in Australia. Medical Journal of Australia, 183 9: 464-471.

Author Lord, Sarah J.
Howard, Kirsten
Allen, Felicity
Marinovich, Luke
Burgess, David C
King, Richard
Atherton, John J.
Title A systematic review and economic analysis of drug-eluting coronary stents available in Australia
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 0025-729X
Publication date 2005-11-07
Sub-type Article (original research)
Volume 183
Issue 9
Start page 464
End page 471
Total pages 7
Place of publication Sydney, N.S.W. Australia
Publisher Australasian Medical Publishing
Language eng
Subject 1103 Clinical Sciences
Formatted abstract

To compare the safety, effectiveness and cost-effectiveness of drug-eluting coronary stents used in Australia with bare-metal stents and determine whether the benefits are greater for high-risk subgroups.
Data sources: 

MEDLINE, Pre-Medline, EMBASE, Current Contents, CINAHL and the Cochrane Library database were searched to identify eligible randomised controlled trials and systematic reviews published in English between January 1966 and June 2004.
Study selection: 

Seven randomised controlled trials that assessed polymer-based paclitaxel- or sirolimus-eluting stents versus bare-metal stents in patients with coronary atherosclerosis and reported on stent thrombosis, mortality, myocardial infarction, coronary artery bypass grafting or target lesion revascularisation.
Data extraction: 

Two independent reviewers appraised eligible studies and extracted data. Relative risks (RRs) were calculated for each outcome and pooled using the Mantel–Haenszel method.
Data synthesis: 

Rates of stent thrombosis, mortality, myocardial infarction and bypass grafts did not differ by stent type. Drug-eluting stents (DESs) resulted in a 71%–80% lower risk of revascularisation at 12 months (RR 0.29 [95% CI, 0.20–0.43] for paclitaxel-eluting stents [n = 1593 patients]; RR 0.20 [95% CI, 0.13–0.29] for sirolimus-eluting stents [n = 1296 patients]). Similar benefits were seen in several high-risk subgroups of patients: those with diabetes, lesion length > 20 mm and target-vessel diameter ≤ 2.5 mm. The benefits of DESs in these high-risk groups over lower-risk groups were inconclusive because of low numbers. The cost per revascularisation avoided by using DESs was A$3750–$6100, with an estimated cost per quality-adjusted-life-year (QALY) gained of A$46 829–$76 467. In sensitivity analyses, estimates varied from DESs being cost-saving to costing an additional $314 385 per QALY gained.

DESs are effective in reducing revascularisation. Estimates of cost-effectiveness are very sensitive to changes in estimates of their true effects in clinical practice, market price and the number of stents used per patient. Decisions to limit DESs to only patients at the highest risk of restenosis may improve their cost-effectiveness but will need to be reassessed when evidence is available to compare absolute benefits between patient groups.

Keyword Coronary atherosclerosis
Cost effectiveness
Mantel-Haenszel method
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Created: Tue, 16 Mar 2010, 15:01:17 EST by Ms May Balasaize on behalf of Faculty Of Health Sciences