Jury still out on the cost-effectiveness of drug eluting stents
March 01, 2005
OTTAWA — The universal adoption of drug eluting stents over bare metal stents would require significant additional health care funding, even when reductions in repeat revascularization procedures are considered, a new report concludes.
Stents are wire mesh devices left permanently in a coronary artery to keep a vessel open after balloon angioplasty. Drug eluting stents are coated with a medication that acts locally to decrease the occurrence of coronary artery re-narrowing (restenosis), a problem that often persists following stent implantation, and which requires repeat treatment procedures.
“While drug eluting stents are more costly than bare metal stents and do not alter death or myocardial infarction rates, they significantly reduce the rate of repeat revascularization interventions and their related costs,” says Nicole Mittmann, the report’s lead author.
The report’s budget impact analysis found that if drug eluting stents were used in all patients requiring them, the cost to the Canadian health care system would be $126.8 million per year, compared to $32.1 million for bare metal stents. But this would be offset by between 2,923 (8.3%) and 5,283 (15%) fewer procedures needed to treat restenosis.
“However, there’s no consensus on what is considered reasonable to pay in Canada to avoid a revascularization procedure,” says Mittmann, making it difficult to draw conclusions about the overall cost-effectiveness of drug eluting stents.
This economic evaluation of the cost-effectiveness of drug eluting stents used decision analytic modeling from both a hospital and provincial health insurance payer perspective, and was based on a systematic review of existing clinical evidence on the use of paclitaxel and sirolimus drug eluting stents compared to bare metal stents.
Coronary artery disease accounts for one-fifth of all deaths in Canada. Narrowing of coronary arteries has a major impact on quality of life, causing chest pain or discomfort and complete blockage can lead to a heart attack.
The full report is available from CCOHTA’s web site at www.ccohta.ca.
CCOHTA is a primary source for unbiased, evidence-based information on drugs, devices, health care systems and best practices. Canadian health care decision makers rely on CCOHTA to help them make well-informed health technology choices. CCOHTA is funded by Canadian federal, provincial and territorial governments. Formed in 1989 to assess medical devices, CCOHTA has evolved into a comprehensive Canadian source for evidence-based health technology information. Our scope includes health technology assessment, the clinical and cost-effectiveness of new drugs, and best practices in drug prescribing and use in Canada. www.ccohta.ca
About HOPE Research Centre
The HOPE Research Centre is an academic affiliated research group located at Sunnybrook & Women’s College Health Sciences Centre. www.hoperesearch.com
For further information, please contact:
Canadian Coordinating Office for Health Technology Assessment
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