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Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitäts Trial (BASKET): an 18-month analysis.
- Source :
-
Lancet (London, England) [Lancet] 2007 Nov 03; Vol. 370 (9598), pp. 1552-9. - Publication Year :
- 2007
-
Abstract
- Background: Our aim was to determine whether drug-eluting stents are good value for money in long-term, everyday practice.<br />Methods: We did an 18-month cost-effectiveness analysis of the Basel Stent KostenEffektivitäts Trial (BASKET), which randomised 826 patients 2:1 to drug-eluting stents (n=545) or to bare-metal stents (281). We used non-parametric bootstrap techniques to determine incremental cost-effectiveness ratios (ICERs) of drug-eluting versus bare-metal stents, to compare low-risk (> or =3.0 mm stents in native vessels; n=558, 68%) and high-risk patients (<3.0 mm stents/bypass graft stenting; n=268, 32%), and to do sensitivity analyses by altering costs and event rates in the whole study sample and in predefined subgroups. Quality-adjusted life-years (QALYs) were assessed by EQ-5D questionnaire (available in 703/826 patients).<br />Findings: Overall costs were higher for patients with drug-eluting stents than in those with bare-metal stents (11,808 euros [SD 400] per patient with drug-eluting stents and 10,450 euros [592] per patient with bare-metal stents, mean difference 1358 euros [717], p<0.0001), due to higher stent costs. We calculated an ICER of 64,732 euros to prevent one major adverse cardiac event, and of 40,467 euros per QALY gained. Stent costs, number of events, and QALYs affected ICERs most, but unrealistic alterations would have been required to achieve acceptable cost-effectiveness. In low-risk patients, the probability of drug-eluting stents achieving an arbitrary ICER of 10,000 euros or less to prevent one major adverse cardiac event was 0.016; by contrast, it was 0.874 in high-risk patients.<br />Interpretation: If used in all patients, drug-eluting stents are not good value for money, even if prices were substantially reduced. Drug-eluting stents are cost effective in patients needing small vessel or bypass graft stenting, but not in those who require large native vessel stenting.
- Subjects :
- Aged
Angioplasty, Balloon, Coronary
Anti-Bacterial Agents adverse effects
Anti-Bacterial Agents economics
Coronary Disease prevention & control
Coronary Disease therapy
Female
Humans
Male
Middle Aged
Paclitaxel adverse effects
Paclitaxel economics
Risk Factors
Sirolimus adverse effects
Sirolimus economics
Stents adverse effects
Anti-Bacterial Agents administration & dosage
Coronary Disease economics
Cost-Benefit Analysis
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Quality-Adjusted Life Years
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Stents economics
Subjects
Details
- Language :
- English
- ISSN :
- 1474-547X
- Volume :
- 370
- Issue :
- 9598
- Database :
- MEDLINE
- Journal :
- Lancet (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 17980734
- Full Text :
- https://doi.org/10.1016/S0140-6736(07)61660-2