Cost-Effectiveness of Palmaz-Schatzª Stenting for Patients with Coronary Artery Disease in Spain

The increasing use of stent implantation in coronary artery disease raises economic concerns for health care decision-makers. This model analysis, applying to the Spanish health care system and using the latest clinical and economic data, demonstrates coronary stent implantation (CSI) in single-vessel disease (SVD) to be clinically and economically superior to conventional balloon angioplasty (PTCA). Although the procedural cost for CSI remains higher than for PTCA (Ptas. 677,000 vs. Ptas. 436,000), this cost difference in the cath lab is decreased to approximately Ptas. 150,000 during the in-hospital period due to avoided procedural complications and associated bail-out treatments. By the end of year one, the incremental cost of CSI is more than recouped through savings in revascularization procedures, and this result is maintained over subsequent years. Combined with a higher rate of event-free patients, this cost-savings clearly improves the cost-effectiveness of CSI, which has a 31.1%, 32.0%, and 33.6% lower cost per event-free survivor than PTCA at the one-, two-, and three-year follow-ups, respectively. In multi-vessel disease, CSI also appears to be a cost-effective alternative to PTCA and perhaps CABG.