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Published on: September 14, 2009
Decision models for assessing the cost effectiveness of drug-eluting stents
David F Kong1, Eric L Eisenstein
1Duke University Medical Centre, Duke Clinical Research Institute, DUMC Box 3850, Durham, NC 27710, USA. kong0008@dcri.duke.edu
Insights
Drug-eluting stents (DES) reduce repeat procedures for coronary artery disease but incur high costs. Further research is needed to identify patients who benefit most from this expensive intervention.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease.
- Drug-eluting stents (DES) have demonstrated reduced need for repeat procedures in randomized trials.
- The widespread adoption of DES presents significant cost challenges for healthcare systems.
Purpose of the Study:
- To review economic decision models for drug-eluting stents (DES) from societal and hospital perspectives.
- To evaluate the cost-effectiveness and clinical benefits of DES in real-world practice.
- To identify patient subgroups that may derive maximal health benefits from DES therapy.
Main Methods:
- Systematic review of published economic decision models for DES.
- Analysis of cost-benefit and cost-effectiveness data from societal and hospital viewpoints.
- Synthesis of evidence on clinical outcomes and economic implications of DES use.
Main Results:
- DES are associated with substantial costs to both society and healthcare providers.
- The clinical benefits of DES in routine practice remain uncertain compared to trial data.
- Economic models indicate potential financial strain on hospital systems due to DES implementation.
Conclusions:
- While DES show promise in reducing repeat procedures, their high cost necessitates careful economic evaluation.
- Further research is crucial to pinpoint high-risk patient populations who can achieve significant health gains from DES.
- A balanced approach considering both clinical efficacy and economic impact is essential for optimal DES utilization.
Abstract:
Percutaneous coronary intervention is an increasingly common treatment for many people with coronary disease. Randomised trials using antiproliferative, drug-eluting stents (DES) have shown important reductions in the need for repeat procedures after initial percutaneous coronary intervention. These trials indicate that the growing use of DES has the potential to create major clinical benefits for patients; however, in actual practice, the associated costs may cause financial crises for hospital systems. This paper reviews previously published DES economic decision models from both societal and hospital perspectives. From a social perspective, additional spending for new technologies may be acceptable if these technologies convincingly improve the lives of patients. The models reviewed suggest that DES incurs large costs to both society and hospitals, and currently offers uncertain clinical benefits. More research is recommended to identify high-risk patients who stand to gain significant health benefits from this therapy.
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