Abstract 3058: At What Price Drug-Eluting Stents Would Be Cost Neutral in Belgium?
Background: There is a solid evidence that the implantation of drug-eluting stents (DES) induces a significant reduction in target vessel revascularization (TVR) in comparison with BMS. No effect on mortality or occurrence of myocardial infarction has been observed . The actual price difference between BMS and DES is ± 1000 €.
Aim: To calculate the acceptable price of DES in order to achieve cost neutrality.
Methods: The study group consists of 474 consecutive patients undergoing their first PTCA procedure (with BMS implantation) in our institution during the year 2002. One-year follow-up was obtained in all patients. The patients’characteristics were: diabetes under medication: 15 % (under insulin: 4%), mean age: 64.7±11.74. Procedural data: multivessel-PTCA: 18,2%; multi-lesion therapy: 39.2%; complete angiographic success: 89,2%; a total of 729 segments were treated (620 BMS were implanted). Events at 1 year: TVR in 36 pts; 32 repeat PTCA (4 brachytherapies) and 6 CABG.
Results: Assuming an average cost of 4.500 € for PTCA and of 10.000 €/CABG procedure, the overall costs of TVR was estimated of 204.000 € in our group. Assuming that the present reimbursement of PTCA and CABG procedures covers all hospital costs, the extrabill (either for the insurances companies or at the expenses of the hospital) for deploying systematically DES (instead of BMS) would have been 620.000 € (!) inducing a subsequent saving of 204.000 € during the first year follow-up period, based on the unrealistic hypothesis that DES abolishes all TVR. The more realistic hypothesis of a 50% reduction of TVR after DES implantation would offer a potential saving of (204.000 x 50%) = 102.000 €. Cost neutrality could only be achieved if the actual price difference would be reduced by a factor 6.
Conclusion : From a public health budget perspective, systematic DES implantation is highly expensive. Only drastic price cuts for DES may offer cost neutrality.