Key result
At 3-year follow-up, percutaneous coronary intervention with the Orsiro sirolimus-eluting stent was dominant, yielding higher mean QALYs (2.566) and lower mean costs (€14,670) compared to the zotarolimus-eluting and everolimus-eluting stents.
Why the study?
Evidence on health economic outcomes comparing different contemporary drug-eluting stents in PCI is scarce, as most previous randomized trials did not evaluate these aspects.
Does the sirolimus-eluting stent or everolimus-eluting stent improve quality-adjusted life years and reduce costs compared to the zotarolimus-eluting stent in patients with obstructive coronary artery disease?
RCT (n=3,514)
Single-blind
1:1:1
Yes
Does the sirolimus-eluting stent or everolimus-eluting stent improve quality-adjusted life years and reduce costs compared to the zotarolimus-eluting stent in patients with obstructive coronary artery disease?
Absolute Event Rate: 2.566% vs 2.55%
At 3-year follow-up, percutaneous coronary intervention with a sirolimus-eluting stent was the most cost-effective strategy compared to everolimus- and zotarolimus-eluting stents, offering slight health benefits and lower costs.
Supports the economic viability of biodegradable versus durable polymer drug-eluting stents; leaves.
BACKGROUND AND OBJECTIVE: Evidence on health economic outcomes for percutaneous coronary intervention (PCI) comparing different contemporary drug-eluting stents (DES) with each other is scarce, as most previous randomised DES trials did not assess such aspects. This prespecified health economic evaluation of the Comparison of Biodegradable Polymer and Durable Polymer Drug-Eluting Stents in an All Comers Population (BIO-RESORT) trial aimed to compare at 3-year follow-up both health effects and costs of PCI with one of three new-generation drug-eluting stents (DES) in patients with obstructive coronary artery disease. METHODS: The randomised BIO-RESORT trial assessed in 3514 patients the ultrathin-strut biodegradable polymer Orsiro sirolimus-eluting stent (SES) and very-thin-strut Synergy everolimus-eluting (EES) stent versus the thin-strut durable polymer Resolute Integrity zotarolimus-eluting stent (ZES). In the current analysis, we used the perspective of a health insurer in the Netherlands. The main endpoints were quality-adjusted life years (QALYs), and costs for each treatment strategy. Bootstrapping with 5000 resamples was performed to capture the uncertainty of results. RESULTS: Mean QALYs for each stent group were 2.566 for the SES, 2.551 for the EES, and 2.550 for the ZES. Mean costs per strategy were €14,670 for the SES, €14,946 for the EES, and €15,069 for the ZES. The SES had the highest probability of being cost-effective for every willingness-to-pay threshold up to €100,000 per QALY. Furthermore, in 79% of modelling scenarios, the SES was more effective and cheaper than ZES. CONCLUSION: At 3-year follow-up, PCI with the SES had the highest probability of being cost-effective due to greater effectiveness and lower costs compared with the ZES and EES. These findings suggest that, due to the overall high volume of coronary stenting in clinical practice, use of this SES could result in substantial cost savings, complemented by slight additional health benefits.
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Ploumen et al. (2024) conducted an RCT in Obstructive coronary artery disease (n=3,514). Orsiro sirolimus-eluting stent (SES) vs. Synergy everolimus-eluting stent (EES) and Resolute Integrity zotarolimus-eluting stent (ZES) was evaluated on Quality-adjusted life years (QALYs). At 3-year follow-up, percutaneous coronary intervention with the Orsiro sirolimus-eluting stent was dominant, yielding higher mean QALYs (2.566) and lower mean costs (€14,670) compared to the zotarolimus-eluting and everolimus-eluting stents.
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