Publication
Title
Cost effectiveness of drug-eluting stents in Belgian practice: healthcare payer perspective
Author
Abstract
Background There has been a steep increase in the number of percutaneous coronary intervention procedures performed for coronary heart disease since their introduction about 30 years ago. Recently, the use of drug-eluting stents (DES) compared with the original bare metal stents (BMS) has increased in many countries. Objective To assess the cost effectiveness of DES versus BMS in a real-world setting from the Belgian healthcare payer perspective. Methods We developed a decision analysis model to estimate incremental costs (year 2004 or 2007 values [depending on the underlying variable]) and effectiveness. Incremental effectiveness was calculated by combining relative benefits from published meta-analyses with real-world observations from a Belgian registry. Probabilistic modelling and sensitivity analyses were performed. The model had a 1-year time horizon. Sixteen sub groups were created based on the following characteristics: initial stent type, diabetic status, complex lesion and multi-vessel disease. Scenario analyses were performed for the influence on reinterventions and the duration of clopidogrel use. In each analysis, 1000 Monte Carlo simulations were performed. Results The incremental costs for switching from BMS to DES are substantial (approximately 1000), while the benefits, expressed as QALYs, are extremely small (on average <0.001 QALYs gained). This led to very high incremental cost-effectiveness ratios: over 860 000 per QALY gained in all subgroups and scenario analyses. Conclusion Comparing DES with BMS, no life-years are gained and small quality-of-life improvements are achieved for short periods, resulting in a high likelihood that DES are not cost effective. When there is competition for scarce resources this should be considered when deciding on the reimbursement of this technology.
Language
English
Source (journal)
Pharmacoeconomics. - Auckland, 1998 - 2015
Publication
Auckland : 2009
ISSN
1170-7690
Volume/pages
27:4(2009), p. 313-327
ISI
000268864300004
Full text (Publishers DOI)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identification
Creation 07.09.2009
Last edited 19.05.2017
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