Authors' objectives:

To examine the cost-effectiveness of drug eluting stents (DES) relative to bare metal stents (BMS) from the perspectives of both a tertiary care hospital and a provincial ministry of health; to examine the impact on expenditures if DES were to become widely adopted in the treatment of patients with coronary heart disease; to address these questions through an economic evaluation and a budget impact analysis.

Authors' recommendations: While DES are more costly than BMS, their use is associated with a significantly lower one-year rate of restenosis, which avoids associated treatment costs. Long-term survival data are unavailable. The economic evaluation found the incremental cost-effective ratio (ICER) per TLR (target lesion revascularization) avoided was higher for paclitaxel DES than for sirolimus DES. This should be interpreted with caution, however, as the two DES were not compared head-to-head and the BMS comparators in the clinical trials were different for paclitaxel and sirolimus. The ICER for DES declines as the price difference between BMS and DES is narrowed. The ICER for DES also declines by targeting populations at higher risk for restenosis post-procedure, such as patients with diabetes. Negotiating a lower DES acquisition cost or implementing criteria for the treatment of high risk patients may make it more acceptable for hospitals and provinces to adopt DES on a wider scale. There is no consensus on an acceptable range of cost per TLR avoided that would be considered cost-effective. The limited literature available suggests that a cost-effectiveness threshold of $10,000 to $15,000 per TLR avoided may be acceptable. Most of this literature, however, cannot be used in a Canadian context and is based on BMS data. The budget impact analysis in this report found that in Ontario, for the estimated 40% of coronary stent patients considered to be at high risk of restenosis, the use of DES rather than BMS would increase costs by $14.6 million. For Canada, the use of DES rather than BMS in high risk restenosis patients would increase costs by $37.9 million annually. If all coronary stent patients were given DES instead of BMS, the budget impact is estimated at $48.9 million for Ontario and $126.8 million for Canada. DES offer a promising alternative for the management of coronary artery disease, particularly in patients at high risk for restenosis. Given that costs were the key source of uncertainty in the analysis, there is a need for better data collection at the provincial and national levels. A national cardiovascular database to record procedural data and costs would meet that need.

Authors' methods: Overview, Economic evaluation

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)