Abstract 6228: Cost-Effectiveness of Drug-Eluting Stents: The Economic Impact of Late Stent Thrombosis
Background: Recent studies examining the effectiveness of drug-eluting stents (DES) have found that the use of DES is associated with a significant increase in the incidence of late stent thrombosis (LST). However, previous cost-effectiveness analyses of DES do not account for the costs associated with LST.
Objectives: The objectives of this study were to examine the costs associated with LST and the resulting impact on the cost-effectiveness of DES.
Methods: We reviewed the literature to identify studies that compared the cost-effectiveness of DES with that of bare metal stents (BMS) and to identify the incidence of LST. We assigned probable costs to LST-related myocardial infarction (MI) and death based on the treatment costs for these outcomes. We then incorporated these costs as well as those of extended clopidogrel therapy into the SIRIUS and TAXUS-IV cost-effectiveness data. We conducted sensitivity analyses to determine how variations in the cost of death and MI and the incidence of LST affect the cost-effectiveness of DES.
Results: Our literature review found that the incidence of LST ranged from 0.2% to 0.7%. Assuming a base case LST incidence of 0.5%, a cost per death of $20,000, a cost per MI of $20,000, and the cost of an additional 2 years of clopidogrel therapy of $2,428 per patient, the cost per revascularization avoided was $15,056 for the SIRIUS trial and $25,210 for the TAXUS-IV trial. The costs per quality-adjusted life-year (QALY) gained were $250,935 and $257,591, respectively. Sensitivity analyses revealed that the costs per revascularization avoided varied from $14,618 to $15,830 for the SIRIUS trial and $24,540 to $26,396 for the TAXUS-IV trial. Similarly, the cost per QALY gained varied from $243,638 to $263,840 for the SIRIUS trial and from $250,739 to $269,708 for the TAXUS-IV trial.
Conclusions: LST-related adverse events and the need for extended clopidogrel therapy substantially increase the costs associated with the implementation of DES. The inclusion of these costs renders the widespread use of DES not cost-effective in the United States, both in terms of cost per QALY and cost per revascularization avoided.