medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2015, Number 4

<< Back Next >>

Rev Invest Clin 2015; 67 (4)

Economic Evaluation of the Use of Drug-Eluting Stents versus Bare-Metal Stents in Adults with Ischemic Cardiomyopathy Requiring Angioplasty

González-Díaz B, Garduño-Espinosa J, Salinas-Escudero G, Reyes-López A, Granados-García V

Language: English
References: 23
Page: 219-226
PDF size: 190.22 Kb.


ABSTRACT

Background: The value of drug-eluting stents in preventing cardiovascular events has not been investigated in Mexico. Objective: To conduct a cost-effectiveness analysis of early and new-generation drug-eluting stents from the perspective of a healthcare provider. Methods: We conducted a cost-effectiveness analysis of early and new-generation drug-eluting stents in patients with ischemic cardiomyopathy attending a Cardiology Hospital of the Mexican Social Security Institute. The health endpoint used was major acute cardiovascular events prevented. The effectiveness by stent type was obtained from the literature. A retrospective chart review study was conducted to collect cost data on cardiovascular events including seven cost categories. Average and incremental cost-effectiveness ratios were estimated. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of estimates. Results: Incremental cost-effectiveness ratios in base-case were 28,910 and US$ 35,590 for early and new-generation stents, respectively. In an optimal scenario, incremental-cost effectiveness ratio was 24,776 and US$ 25,262 for early and new stents, respectively. Probabilistic sensitivity analysis suggested that 90% of cases were cost-effective when willingness-to-pay was 58,000 and US$ 66,000 for early and new-generation stents, respectively. Conclusions: The cost-effectiveness ratios of early and new-generation stents were significantly higher than corresponding bare-metal stents.


REFERENCES

  1. Instituto Nacional de Estadística y Geografía (INEGI). Interactive Consultation of Mortality Data (In Spanish). Mexico. 2012. Available at: http://www.inegi.org.mx/lib/olap/consulta/ general_ver4/MDXQueryDatos.asp?proy=mortgral_mg [11 August 2014].

  2. Salam A, Suwaidi J, Holmes D. Drug-eluting coronary stents. Curr Probl Cardiol. 2006;31:8-119.

  3. Sousa JE, Costa MA, Abizaid. Lack of neointimal proliferation after implantation of Sirolimus coated stents in human coronary arteries: A quantitative coronary angiography and tree dimensional intravascular ultrasound study. Circulation. 2001; 103:192-5.

  4. Stefanini GG, Holmes DR. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368:254-65.

  5. Kastrati AD, Spaulding C, Laarman GJ, et al. Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction. Eur Heart J. 2007; 28:2706-13.

  6. Kolandaivelu K, Swaminathan R, Gibson WJ, et al. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation. 2011;123:1400-9.

  7. Neyt M, Brabandt HV, Devriese S, et al. Cost-effectiveness analyses of drug eluting stents versus bare metal stents: A systematic review of the literature. Health Policy. 2009;91:107-20.

  8. Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug eluting and bare metal coronary stents. Circulation. 2012;125:2873-91.

  9. Instituto Mexicano del Seguro Social (IMSS). Unitary costs by level of health care for 2013 to be used for fiscal purposes and tariffs for persons who are not insured by IMSS (In Spanish). Mexico. IMSS. 24 July 2013. Available at: http://www.portalfiscal.com.mx/pagina/ principal/transferencias%20dof/varios/2013/IMSS/Costos% 20de%20atencion%20medica%202013.htm.

  10. Instituto Mexicano del Seguro Social (IMSS). Purchasing information web site (In Spanish). Mexico. IMSS. 12 August 2014. Available at: http://compras.imss.gob.mx/?P=imsscompro.

  11. Banco Nacional de México (Banxico). Official exchange data (In Spanish). Available at: http://www.banxico.org.mx/SieInternet/ consultarDirectorioInternetAction.do?accion=consultarCuadro& idCuadro=CF102§or=6&locale=en. [10 July 2014].

  12. Instituto Nacional de Estadística y Geografía (INEGI). National Consumer Price Index (In Spanish). Mexico. 2014. Available at: http://www.inegi.org.mx/sistemas/IndicePrecios/Cuadro. aspx?nc=CA57&T=Índices de Precios al Consumidor&ST=Índice Nacional de Precios al Consumidor, clasificación objeto del gasto. [6 July 2014].

  13. Roiron C, Sanchez P, Bouzamondo A, et al. Drug eluting stents: An updated meta-analysis of randomized controlled trials. Heart. 2006;92:641-9.

  14. Stone GW, Rizvi A, Sudhir K, et al. Randomized comparison of everolimus- and paclitaxel-eluting stents. J Am Col Card. 2011;58:20-5.

  15. Babapulle M, Joseph L, Brophy J, et al. A hierarchical Bayesian meta-analysis of randomized clinical trials of drug-eluting stents. Lancet. 2004;364:583-91.

  16. Kang SH, Park KW, Kang DY, et al. Biodegradable-polymer drugeluting stents vs. bare-metal stents vs. durable-polymer drugeluting stents: A systematic review and Bayesian approach network meta-analysis. Eur Heart J. 2014;35:1147-58.

  17. Park KW, Kang SH, Velders MA, et al. Safety and efficacy of everolimus- versus sirolimus-eluting stents: A systematic review and meta-analysis of 11 randomized trials. Am Heart J. 2013; 165:241-50.

  18. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: A collaborative network meta-analysis. Lancet. 2007;370:937-48.

  19. Hill R, Boland A, Dickson R, et al. Drug-eluting stents: A systematic review and economic evaluation. Health Technol Assess. 2007;11:46.

  20. Kaiser C, Brunner-La Rocca HP, Buser PT, et al. Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a realworld setting: Randomised Basel Stent Kosten Effektivitäts Trial (BASKET). Lancet. 2005;366:921-9.

  21. Brunner-La Rocca HP, Kaiser C, Pfisterer M; BASKET Investigators. Targeted stent use in clinical practice based on evidence from the BAsel Stent Cost Effectiveness Trial (BASKET). Eur Heart J. 2007;28:719-25.

  22. Varani E, Guastaroba P, Di Tanna GL, et al. Long-term clinical outcomes and cost-effectiveness analysis in multivessel percutaneous coronary interventions: Comparison of drugeluting stents, bare-metal stents and a mixed approach in patients at high and low risk of repeat revascularisation. Eurointervention. 2010;5:953-61.

  23. Carrillo Gómez DC, Ortiz Sierra MC, Cepeda Gil, et al. Costo efectividad de stents liberadores de fármacos versus stents convencionales en el manejo de la enfermedad coronaria. Revisión sistemática de la bibliografía. Rev Argent Cardiol. 2012;80:366-76.




2020     |     www.medigraphic.com