Authors' objectives:

This report aims to provide guidance on the future use of drug eluting (coated) stents for percutaneous coronary interventions. These new devices are expected to cost approximately five times the price of regular stents and it is imperative to fully assess their safety, efficacy and cost-effectiveness.

Authors' recommendations: Acceptance of a policy of replacing bare metal stents with the new coated versions might avoid the need for a repeat angioplasty for approximately 100 patients per year. It would not prevent any deaths or myocardial infarctions. The net cost to the MUHC of this policy would likely be in the vicinity of 2-3 million CDN dollars per year. Even a policy of restricted use (10-15%) would have a substantial budgetary impact for limited health benefits. The TAU committee believes that in the absence of any fresh budget to meet this demand, the reduction in hospital services that would result from this fresh expenditure would be unjustifiable. TAU therefore recommends: 1. That despite good evidence supporting the efficacy of coated stents to reduce the rate of restenosis, the current budget of the hospital should not be redistributed to permit the routine acquisition of drug eluting stents. Thus in the absence of a specially dedicated provincial budget for this technology, coated stents should not be provided by the MUHC except for special circumstances. 2. The special cases requiring a coated stent should be approved by two members of the Division of Cardiology, ideally two interventional cardiologists. 3. The evidence on which this policy recommendation is based is likely to be very time sensitive. The decision should be frequently reviewed and modified if necessary in the light of such evidence. The responsibility for requesting review can be initiated by either the Division of Cardiology or the Technology Assessment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.mcgill.ca/tau/publications/2003

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)