Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Interv Cardiol. 2007 Feb;20(1):1-9.

The costs and quality-of-life outcomes of drug-eluting coronary stents: a systematic review.

Author information

  • 1Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. peter.groeneveld@va.gov

Abstract

OBJECTIVES:

While the efficacy of drug-eluting coronary stents (DES) has been demonstrated by several clinical trials, the impact of DES on health-care costs and recipient quality of life (QOL) is controversial. We performed a systematic review of the published literature on DES costs and the QOL effects of restenosis and target vessel revascularization (TVR).

METHODS:

Among 536 potential articles initially identified by a broad search, 12 publications ultimately met inclusion criteria. Data were independently abstracted, evaluated for quality and relevance, and summarized by two reviewers. Excessive heterogeneity among these studies prevented formal meta-analysis, thus a narrative synthesis of the literature was performed.

RESULTS:

In four economic studies, DES recipients had 1,600 dollars-3,200 dollars higher up-front costs than recipients of bare metal stents, but the differences in total costs after 1 year were less pronounced (200 dollars-1,200 dollars), and estimates of the average cost of an avoided revascularization ranged widely (1,800 dollars-36,900 dollars). All eight QOL studies indicated that restenosis was associated with lower QOL, but only two studies quantified this in terms of quality-adjusted life years (QALYs), with estimates ranging from 0.06 to 0.08. An additional study estimated that the median willingness to pay to prevent restenosis was 2,400 dollars-3,600 dollars.

CONCLUSIONS:

There is a lack of convergence in the literature on the cost of DES in avoiding TVR. There is more agreement that the average QALY benefit of an avoided revascularization is 0.04-0.08. This implies that use of DES in patients where the average cost per avoided revascularization exceeds 8,000 dollars may be less likely to be cost-effective.

PMID:
17300390
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Blackwell Publishing Icon for PubMed Health
    Loading ...
    Write to the Help Desk