Cost-effectiveness of drug-eluting stents in the treatment of coronary artery disease

ABSTRACT

Technology: Drug Eluting Stents (DES)

Indication: Myocardial revascularization in patients with coronary artery disease.

Technology Characterization: DES are based on the principle of local administration, using the bare metal stents (BMS) as a platform to adduce the bioactive principle. The agents used in DES are highly lipophilic molecules and are distributed into the artery doing an immunosuppressive effect or antiproliferative effects on the smooth muscle cells of the artery.

Question: Drug-eluting stents are more cost-effective than BMS?

Search and analysis of evidence: We searched Medline (via Pubmed) and Embase. We searched for systematic reviews of economic studies and economic studies that compared DES with BMS. Were also selected Health Technology Assessments (HTA) from international agencies and from the Brazilian Network for Health Technology Assessment (Rede Brasileira de Avaliação de Tecnologias em Saúde – REBRATS). We selected studies published in english, portuguese or spanish, from 2009.

Summary results of the selected studies: Nine economic studies and systematic review of economic studies considered as effectiveness measures survival, rate of re-intervention, restenosis rates and major adverse cardiovascular events. The studies were conducted in several countries, each with a specific context. In general, studies have shown that BMS were more cost-effective than DES in one year time horizon, but in long term and for high-risk patients, DES showed better cost-effectiveness ratio. Only one Brazilian study was included and it found that DES performed better than BMS, when considering the re-intervention as the effectiveness measure.

Recommendations: In terms of cost-effectiveness and taking into account the Brazilian context, are needed studies considering all costs involved in the treatment, like the costs of the stent, stenting procedure, and complications treatment, the use of antiplatelet therapy and quality of life of patients. Also, is required the precise definition of clear intermediate and finalistic outcomes. So we can reach a conclusion about real cost-effectiveness of drug-eluting stents in Brazil.

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