Percutaneous coronary intervention (PCI) is a commonly used procedure for the treatment of coronary artery disease. In Australia, most PCIs are now performed with the use of coronary stents. Despite this, restenosis remains the Archilles' heel of coronary stenting. Recent technological advances have led to the development of drug-eluting stents (DES), which offer a new perspective for the prevention of restenosis. The objective of this study is to conduct a cost-effectiveness analysis of PCI with DES, relative to BMS in the long term.
The studies identified in the literature review demonstrated that DES compared with bare metal stent (BMS) substantially reduced the incidence of repeat revascularization by 70%-80% in patients with de novo lesions over a four-year follow-up period. No apparent differences in mortality, MI rate or stent thrombosis rates between DES and BMS were found. However, this new technology is associated with substantial acquisition costs. This study examined the cost-effectiveness of DES relative to BMS based on a four-year clinical data from the Australian health sector perspective.
The results from the analysis indicate that the incremental cost-effectiveness ratios (ICERs) are high for general population, with an ICER of $4,724 per revascularization procedure avoided and $136,926 per DALY avoided over four-year period. The cost-effectiveness of DES was found to be more favourable in patients with diabetes, with an ICER of $1,699 per revascularization avoided and $49,081 per DALY avoided.
In the presence of budget constraints and other considerations, the results suggest that the use of DES in preference to BMS should be restricted to patients with simple lesions, single vessel occlusion or patients in high risk of developing restenosis.
DES offers a promising alternative for the management of coronary artery disease, particularly in patients at high risk for restenosis. Given that costs were the key source of uncertainty in the analysis, a change in price or an improvement in technology may alter these conclusions. It is suggested that there is a need for better data collection at the national level to improve the assessment of effectiveness and cost effectiveness associated with DES in the local context.