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Economic evaluation of drug-eluting stents compared to bare metal stents using a large prospective study in Ontario

Published online by Cambridge University Press:  31 March 2009

Ron Goeree
Affiliation:
McMaster University
James M. Bowen
Affiliation:
McMaster University
Gord Blackhouse
Affiliation:
McMaster University
Charles Lazzam
Affiliation:
Trillium Health Centre
Eric Cohen
Affiliation:
University of Toronto
Maria Chiu
Affiliation:
University of Toronto
Rob Hopkins
Affiliation:
McMaster University
Jean-Eric Tarride
Affiliation:
McMaster University
Jack V. Tu
Affiliation:
University of Toronto

Abstract

Objectives: To determine the cost-effectiveness (CE) and cost-utility (CU) of drug-eluting stents (DES) compared to bare metal stents (BMS) in Ontario using a large prospective “real-world” cohort study and determine the extent to which results vary by patient risk subgroups.

Methods: A field evaluation was conducted based on all stent procedures in the province of Ontario between December 1, 2003, and March 31, 2005, with a minimum subject follow-up of 1 year. Effectiveness data from the study using a propensity-score matched cohort were combined with resource utilization and cost data and quality of life (QOL) data from the published literature in a decision analytic modeling framework to determine 2-year cost-effectiveness (cost per revascularization avoided) and cost-utility (cost per quality-adjusted life-year ([QALY] gained). Stochastic model parameter uncertainty was expressed using probability distributions and analyzed using a probabilistic model. Modeling assumptions were assessed using traditional deterministic sensitivity analysis.

Results: Significant differences in revascularization rates were found for patients with two or more high risk factors. Despite these differences, the CE and CU of DES remained high (e.g., $419,000 per QALY gained in the most favorable patient risk subgroup). In sensitivity analysis, the difference in cost between DES and BMS had an impact on the CE and CU results. For example, at a price differential of $500, the CU of DES was $20,000/QALY for one patient subgroup and DES was dominant (i.e., less costly and more effective) in another.

Conclusions: At current prices, the CE/CU of DES compared with BMS is high even in patient high risk subgroups. As the relative price of DES decrease, the value for money attractiveness of DES increases, especially for selected high risk patients.

Type
General Essays
Copyright
Copyright © Cambridge University Press 2009

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