Abstract 4608: Sirolimus Eluting Stent is More Cost Effective but Lead to a Higher Stent Thrombosis Rate in Diabetic Patients With Multiple Vessel Disease Than in Non-diabetic Patients: The Evastent Study
Background: EVASTENT is a nationwide matched-cohort registry allowing a direct comparison of diabetic (db+) and non-diabetic patients (db−) after SES implantation, according to the number of diseased vessels (single (SVD) or multiple (MVD)). We present the 3-year safety (death, stent thrombosis -ST- rates) and efficacy results (TLR rates) in these 4 subsets of pts, as well as cost efficacy (incremental cost/avoided revascularization) and cost-utility (cost/QUALY) of SES vs BMS.
Methods: 1731 patients (488 db + SVD, 356 db + MVD, 513 db− SVD, and 374 db− MVD) were treated with SES. Direct hospital costs for hospitalization, PCI, BMS, SES, CABG, as well as costs for drugs (including clopidogrel) were measured for the SES arm. Trajectories for costs and clinical outcomes were derived from a Markov model and Monte Carlo simulations, with 3 month intervals over a 3-year time horizon. The parameters in the SES arm were derived from EVASTENT data, whereas transition probabilities in the BMS arm were derived from the SES arm according to previous randomized studies: RR of TLR=0.30 with SES/BMS during the first year, then RR=1 after one year, with no difference for the 3-year death and ST rates. Sensitivity analyses according to the price premium and RR of TLR have been performed. SES were considered cost effective if <10 000 Euros/TLR avoided.
Results: Safety concerns were noted in MVD db + pts with higher 3-year stent thrombosis rate (5.9%) than in SVD db + (3.5%), MVD db− (3.5%) and SVD db− (1.8%). A new revascularisation was needed for 299 (17.2%) patients, including 45 (2.6%) CABG: 125 TLR (7.2%), and 192 (11%) non-TLR procedures. Table 1⇓ gives the 3-year cost effectiveness results. SES was cost effective in MVD db+ patients. Sensitivity analyses demonstrated dominance of SES in such patients if the price premium between SES and BMS is 400 Euros.
Conclusion: SES are cost effective when compared to BMS in MVD diabetic patients, but these patients have a relatively high stent thrombosis rate.