Clinical and economic outcomes after introduction of drug-eluting stents

Charanjit S. Rihal, James L. Ryan, Mandeep Singh, Ryan J. Lennon, John F. Bresnahan, Juliette T. Liesinger, Bernard J. Gersh, Henry H. Ting, David R. Holmes, Kirsten Hall Long

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4 Scopus citations

Abstract

Background: In clinical trials, drug-eluting stents (DES) improve clinical outcomes but are more expensive than bare-metal stents (BMS). Objective: To assess clinical and economic outcomes of all percutaneous coronary intervention (PCI) procedures in a general interventional cardiology practice before and after DES introduction in 2003. Methods: We identified all patients undergoing PCI in 2000-2002 (early cohort, pre-DES era) and from 2004 through April 31, 2006 (late cohort, DES era) in a large PCI registry. Logistic and Cox proportional hazard models estimated the risk of adverse events; generalized linear modeling predicted economic outcomes. Results: We compared 4303 early-cohort patients with 3422 late-cohort patients. Most early-cohort patients (90%) had BMS implanted; the rest had atherectomy or balloon angioplasty only. Among late-cohort patients, 83% had DES, 14% BMS, and 6% balloon angioplasty or atherectomy only. In-hospital adverse-event rates and incidence of death or myocardial infarction (during a median follow-up of 22 months) were similar. Follow-up procedures were significantly fewer in the later era (hazard ratio for target lesion revascularization: 0.58; 95% confidence interval [CI], 0.50-0.68). Although catheterization lab supply costs were higher in the DES era, length of stay following index PCI and overall practice costs were reduced, on average, 0.40 days and $2053 in the late cohort (95% bootstrapped CI of adjusted mean difference, -$2937 to -$1197). Follow-up cardiac hospitalization costs were similar at 1 year. Conclusions: Patients undergoing PCI following DES introduction experienced improved clinical outcomes during follow-up and reduced overall procedural costs, despite higher stent acquisition costs.

Original languageEnglish (US)
Pages (from-to)580-587
Number of pages8
JournalAmerican Journal of Managed Care
Volume16
Issue number8
StatePublished - Aug 1 2010

ASJC Scopus subject areas

  • Health Policy

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    Rihal, C. S., Ryan, J. L., Singh, M., Lennon, R. J., Bresnahan, J. F., Liesinger, J. T., Gersh, B. J., Ting, H. H., Holmes, D. R., & Long, K. H. (2010). Clinical and economic outcomes after introduction of drug-eluting stents. American Journal of Managed Care, 16(8), 580-587.