Why the study?
Does a drug eluting stent first-line strategy improve cost-effectiveness compared to a bare metal stent first-line strategy in patients with stable coronary artery disease?
Does a drug eluting stent first-line strategy improve cost-effectiveness compared to a bare metal stent first-line strategy in patients with stable coronary artery disease?
Absolute Event Rate: 60% vs 58%
In a 2-year simulation model for stable coronary artery disease, a BMS-first strategy was slightly less efficacious but more cost-effective than a DES-first strategy.
BMS may remain cost-effective first-line in stable CAD; leaves open need for randomized trials on long-term efficacy.
The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.
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Ariel Béresniak (2015) studied stable coronary artery disease. Drug eluting stents (DES) vs. Bare metal stent (BMS) was evaluated on treatment success (absence of major adverse cardiac events).
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