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Cost effectiveness of drug eluting coronary artery stenting in a UK setting: cost-utility study
A Bagust1, A D Grayson, N D Palmer
1University of Liverpool Management School, Liverpool, UK. A.Bagust@liv.ac.uk
Insights
Drug-eluting stents (DES) are not cost-effective for most UK patients with coronary artery disease compared to conventional stents. Lowering the price premium is crucial for wider adoption of this effective technology.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Symptomatic coronary artery disease necessitates effective treatment strategies.
- Drug-eluting stents (DES) offer potential advantages over conventional stents in reducing repeat revascularization.
- Assessing the economic viability of new medical technologies is crucial for healthcare systems.
Purpose of the Study:
- To evaluate the cost-effectiveness of DES versus conventional stents for treating symptomatic coronary artery disease in the UK.
- To determine the economic threshold for justifying the use of DES based on price premiums.
Main Methods:
- A cost-utility analysis was performed using audit data from 2884 patients undergoing percutaneous coronary intervention with stenting.
- Economic modeling was employed to estimate cost-utility ratios and threshold price premiums.
- Patient subgroups were analyzed based on risk factors for repeat revascularization within 12 months.
Main Results:
- Cost-utility ratios were acceptable only for a small subgroup of high-risk, non-elective surgery patients.
- Restricting DES use to 4% of cases marginally improved economic outcomes.
- The price premium threshold for 90% substitution of conventional stents was estimated at £112 for sirolimus and £89 for paclitaxel stents.
Conclusions:
- At current UK prices, DES are not cost-effective for the majority of patients with coronary artery disease.
- While DES technology is effective, widespread adoption is not economically justified without a significant reduction in price premium.
- Targeted use in high-risk patient subgroups may offer some cost-effectiveness.
Objective:
To assess the cost effectiveness of drug eluting stents (DES) compared with conventional stents for treatment of symptomatic coronary artery disease in the UK.
Design:
Cost-utility analysis of audit based patient subgroups by means of a simple economic model.
Setting:
Tertiary care.
Participants:
12 month audit data for 2884 patients receiving percutaneous coronary intervention with stenting at the Cardiothoracic Centre Liverpool between January 2000 and December 2002.
Main Outcome Measures:
Risk of repeat revascularisation within 12 months of index procedure and reduction in risk from use of DES. Economic modelling was used to estimate the cost-utility ratio and threshold price premium.
Results:
Four factors were identified for patients undergoing elective surgery (n = 1951) and two for non-elective surgery (n = 933) to predict risk of repeat revascularisation within 12 months. Most patients fell within the subgroup with lowest risk (57% of the elective surgery group with 5.6% risk and 91% of the non-elective surgery group with 9.9% risk). Modelled cost-utility ratios were acceptable for only one group of high risk patients undergoing non-elective surgery (only one patient in audit data). Restricting the number of DES for each patient improved results marginally: 4% of stents could then be drug eluting on economic grounds. The threshold price premium justifying 90% substitution of conventional stents was estimated to be 112 pound sterling (212 USD, 162 pound sterling) (sirolimus stents) or 89 pound sterling (167 USD, 130 pound sterling) (paclitaxel stents).
Conclusions:
At current UK prices, DES are not cost effective compared with conventional stents except for a small minority of patients. Although the technology is clearly effective, general substitution is not justified unless the price premium falls substantially.
