Abstract 4553: Comparison of the Cost-Effectiveness of Sirolimus-Eluting versus Bare-Metal Stents in Relation to Patient Coronary Artery Disease Status
Objective: To evaluate the cost-effectiveness of sirolimus-eluting stents (SES) to bare-metal stents (BMS) in patients with single-vessel coronary artery disease (SVD) compared with patients with multi-vessel disease (MVD).
Methods: In the prospective GERSHWIN study (German Stent Health Outcome and Economics Within Normal Practice) in 35 hospitals in Germany, patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) were electively treated with SES or BMS (sequential control design). Standardized questionnaires completed by patients and physicians through 18 months following PCI documented major adverse coronary events (MACE), including death, myocardial infarction, coronary artery bypass surgery and re-PCI in target vessel, as well as disease-related direct and indirect costs.
Results: From April 2003 until June 2005, 658 patients were treated with SES (87% male, mean age 63±9) und 294 patients with BMS (79% male, mean age 64±10). SVD was documented in 34% BMS patients and 29% SES patients. After 36 months, 16% of SES vs 29% of BMS patients with SVD had suffered MACE (p adjusted=0.026) and 30% of SES vs 29% of BMS patients with MVD (p=0.714), indicating a difference in the effect of SES with respect to the underlying CAD status. In SVD, SES and BMS incurred total costs of EUR 14,305 vs 14,512 (p=0.701) and in MVD, SES and BMS incurred total costs of EUR 17,146 vs 14,894 (p=0.017). The implantation of SES in patients with SVD represents a cost-saving of €1,584 per avoided MACE, whereas in patients with MVD, there was no clinical benefit and higher cost compared to BMS.
Conclusions: After 36 months, in patients with single-vessel coronary disease, implantation of SES reduces MACE and is cost effective, whereas in patients with multi-vessel disease, MACE is not reduced by the implantation of SES and not cost effective compared to BMS.