Drug-Eluting Stents Not Cost-Effective In All Patients
If used in all patients, drug-eluting stents are not good value for money, even if prices were to be substantially reduced. However they are cost-effective in a subset of high-risk patients. These are the conclusions of authors of an Article in this week's edition of The Lancet.
Professor Matthias Pfisterer, University Hospital, Basel, Switzerland, and colleagues did an 18-month cost-effectiveness study of the Basel Stent KostenEffekitvitäs Trial (BASKET), which featured patients that had been fitted with drug-eluting stents or bare-metal stents in a ratio of around 2:1. The incremental cost-effectiveness ratios (ICERs) for both low-risk* and high-risk** patients were determined using a statistical technique, and quality-adjusted life years (QALYS)*** were assessed through patient questionnaires.
They found that overall costs were higher for patients with drug-eluting stents (€11 808 per patient) than in those with bare-metal stents (€10 450 per patient), a mean difference of $1358 due to drug-eluting stents costing more. They calculated an ICER of €64 732 to prevent one major adverse cardiac event for drug-eluting stents, and of €40467 per QALY gained.
The authors say: "Our data, based on a comprehensive cost-effectiveness analysis of a randomised controlled trial in unselected, real world patients, using the latest stent technology with long-term follow-up, show that drug-eluting stents are not cost effective if used in all patients, compared with other accepted medical procedures. However, in a subset of high-risk patients with small vessel or bypass-graft stenting, which represented about a third of the study sample, drug-eluting stents were truly cost-effective or even cost saving."
Further, they add that it seems "almost impossible" that drug-eluting stents could become cost-effective in low risk patients with large native vessel stenting, even when such patients have additional high-risk characteristics. They conclude: "Thus, targeted stent use could be the preferred strategy today. Lower prices of drug-eluting stents alone are unlikely to result in such stents being cost effective in all patients, even if the problems of late stent thrombosis are solved with new generations of drug-eluting stents."
*Low-risk patients: 3•0 mm or larger diameter stents in native vessels
**High-risk patients: less than 3•0 mm diameter stents or bypass graft stenting
***QALYS are a way of measuring both the quality and the quantity of life lived, as a means of quantifying in benefit of a medical intervention