| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3496237 | The Lancet | 2007 | 8 Pages |
SummaryBackgroundOur aim was to determine whether drug-eluting stents are good value for money in long-term, everyday practice.MethodsWe 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 (≥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).FindingsOverall costs were higher for patients with drug-eluting stents than in those with bare-metal stents (€11 808 [SD 400] per patient with drug-eluting stents and €10 450 [592] per patient with bare-metal stents, mean difference €1358 [717], p<0·0001), due to higher stent costs. We calculated an ICER of €64 732 to prevent one major adverse cardiac event, and of €40 467 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 or less to prevent one major adverse cardiac event was 0·016; by contrast, it was 0·874 in high-risk patients.InterpretationIf 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.
