Cost-effectiveness of sirolimus-eluting stents compared with vascular brachytherapy for the treatment of in-stent restenosis

Matthew R. Reynolds, Duane S. Pinto, Chunxue Shi, Joshua Walczak, Ronna Berezin, David R. Holmes, David J. Cohen

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1221-1227
Number of pages7
JournalAmerican heart journal
Volume154
Issue number6
DOIs
StatePublished - Dec 1 2007

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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