on July 19, 2004
Published online before print July 19, 2004, doi: 10.1161/01.CIR.0000136821.99814.43
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Submitted on January 4, 2004
From the Harvard Clinical Research Institute, Boston, Mass (D.J.C., A.B., C.S., L.G., T.L., R.H.B., R.E.K.); Division of Cardiology, Beth Israel-Deaconess Medical Center, Boston, Mass (D.J.C., A.B., J.P.C.); Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, UK (A.B.); Lenox Hill Hospital, New York, NY (M.B.L., J.W.M.); and Duke University Medical Center, Durham, NC (J.P.Z.). * To whom correspondence should be addressed. E-mail: dcohen{at}caregroup.harvard.edu.
Background--Recently, sirolimus-eluting stents (SESs) have been shown to dramatically reduce the risk of angiographic and clinical restenosis compared with bare metal stent (BMS) implantation. However, the overall cost-effectiveness of this strategy is unknown. Methods and Results--Between February and August 2001, 1058 patients with complex coronary stenoses were enrolled in the SIRIUS trial and randomized to percutaneous coronary revascularization with either a SES or BMS. Clinical outcomes, resource use, and costs were assessed prospectively for all patients over a 1-year follow-up period. Initial hospital costs were increased by $2881 per patient with SESs. Over the 1-year follow-up period, use of SESs led to substantial reductions in the need for repeat revascularization, including repeat percutaneous coronary intervention and bypass surgery. Although follow-up costs were reduced by $2571 per patient with SESs, aggregate 1-year costs remained $309 per patient higher. The incremental cost-effectiveness ratio for SES was $1650 per repeat revascularization event avoided or $27 540 per quality-adjusted year of life gained, values that compare reasonably with other accepted medical interventions. Under updated treatment assumptions regarding available stent lengths and duration of antiplatelet therapy, use of SESs was projected to reduce total 1-year costs compared with BMSs. Conclusions--Although use of SESs was not cost-saving compared with BMS implantation, for patients undergoing percutaneous coronary intervention of complex coronary stenoses, their use appears to be reasonably cost-effective within the context of the US healthcare system.
Revised on April 20, 2004
Accepted on April 22, 2004
Cost-Effectiveness of Sirolimus-Eluting Stents for Treatment of Complex Coronary Stenoses. Results From the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) Trial
David J. Cohen MD, MSc*,
Key words: cost-benefit analysis • restenosis • sirolimus • stents
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