TY - JOUR
T1 - Cost-effectiveness of sirolimus-eluting stents compared with vascular brachytherapy for the treatment of in-stent restenosis
AU - Reynolds, Matthew R.
AU - Pinto, Duane S.
AU - Shi, Chunxue
AU - Walczak, Joshua
AU - Berezin, Ronna
AU - Holmes, David R.
AU - Cohen, David J.
N1 - Funding Information:
Funding for this study was provided by Cordis Corporation, Warren, NJ, a Johnson and Johnson Company.
PY - 2007/12
Y1 - 2007/12
N2 - Background: Sirolimus-eluting stents (SESs) were recently shown to be superior to vascular brachytherapy for the treatment of restenosis within a bare metal stent. No economic comparison of these alternative strategies has yet been reported. Methods: We conducted a prospective health economic study involving all patients randomized to SES (n = 259) or brachytherapy (n = 125) in the SISR trial. Procedural, hospital, and outpatient costs, as well as physician fees, were estimated through 12 months based on measured resource use and itemized hospital bills. Cost-effectiveness was assessed in terms of the cost per repeat revascularization avoided, cost per major adverse cardiac event avoided, and cost per event-free patient. Results: Although initial device costs were approximately $1100/patient higher in the SES group, this was offset by higher physician fees associated with brachytherapy, such that initial hospitalization costs were similar for the 2 groups. Because SES significantly reduced repeat revascularization procedures and major adverse cardiac event compared with brachytherapy during follow-up, cumulative 12-month costs were significantly lower in the SES group ($16 482 vs $19 435, mean difference -$2953, 95% CI -$5470 to -$792). Sirolimus-eluting stenting was thus both more effective and less expensive than brachytherapy, as confirmed in >98% of bootstrap replications for each of the cost-effectiveness outcomes. Conclusions: Compared with vascular brachytherapy, SES is an economically dominant strategy for the treatment of in-stent restenosis.
AB - Background: Sirolimus-eluting stents (SESs) were recently shown to be superior to vascular brachytherapy for the treatment of restenosis within a bare metal stent. No economic comparison of these alternative strategies has yet been reported. Methods: We conducted a prospective health economic study involving all patients randomized to SES (n = 259) or brachytherapy (n = 125) in the SISR trial. Procedural, hospital, and outpatient costs, as well as physician fees, were estimated through 12 months based on measured resource use and itemized hospital bills. Cost-effectiveness was assessed in terms of the cost per repeat revascularization avoided, cost per major adverse cardiac event avoided, and cost per event-free patient. Results: Although initial device costs were approximately $1100/patient higher in the SES group, this was offset by higher physician fees associated with brachytherapy, such that initial hospitalization costs were similar for the 2 groups. Because SES significantly reduced repeat revascularization procedures and major adverse cardiac event compared with brachytherapy during follow-up, cumulative 12-month costs were significantly lower in the SES group ($16 482 vs $19 435, mean difference -$2953, 95% CI -$5470 to -$792). Sirolimus-eluting stenting was thus both more effective and less expensive than brachytherapy, as confirmed in >98% of bootstrap replications for each of the cost-effectiveness outcomes. Conclusions: Compared with vascular brachytherapy, SES is an economically dominant strategy for the treatment of in-stent restenosis.
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U2 - 10.1016/j.ahj.2007.07.033
DO - 10.1016/j.ahj.2007.07.033
M3 - Article
C2 - 18035097
AN - SCOPUS:36148964074
SN - 0002-8703
VL - 154
SP - 1221
EP - 1227
JO - American heart journal
JF - American heart journal
IS - 6
ER -