Are Drug-Eluting Stents Cost-Effective?

ince their commercial introduction in 2003, drugeluting stents (DES) have rapidly altered the management of coronary artery disease. Before their development, the percutaneous management of coronary artery disease was performed predominantly by implantation of bare metal stents (BMS) made of either surgical stainless steel or metal alloys. Although such stents represented a considerable advance over balloon angioplasty alone, they remained limited by restenosis resulting from neointimal proliferation. As a result, 15% to 20% of patients treated with BMS required 1 repeat revascularization procedure within the 6 to 12 months after stent implantation. 1 Despite numerous attempts at systemic pharmacotherapy, device modification, and even use of ionizing radiation, the rate of restenosis after BMS implantation remained largely unaffected.