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BASKET: Lower event rate with drug-eluting stents
In comparison with bare-metal stents, drug-eluting stents were not as cost effective.
Drug-eluting stents may not be cost effective for most patients, according to results of the BASKET trial.
“Based on these real-world, prospective, randomized findings, drug-eluting stents should be restricted to high-risk, elderly patient subsets until the price of these [drug-eluting] stents falls significantly,” Matthias Pfisterer, MD, of the University Hospital in Basel, Switzerland, said at the European Society of Cardiology Congress 2005 in Stockholm.
Pfisterer presented results from BASKET (Basel Stent Kosten Effektivitats Trial), which randomized 826 consecutive patients undergoing percutaneous coronary intervention to either treatment with a sirolimus-eluting stent (Cypher, Cordis), a paclitaxel-eluting stent (Taxus, Boston Scientific) or a third-generation bare-metal stent (Vision, Guidant). All procedures were done at the University Hospital in Basel.
The mean age of the patients was 64 years and 79% were men. Hypertension was present in 67% and 75% had hypercholesterolemia; 21% had ST-elevation MI.
After a six-month follow-up, patients treated with drug-eluting stents had a lower rate of major adverse cardiovascular events at 7.2% compared to 12.1% with bare-metal stents. As in previous drug-eluting stent trials, this was primarily driven by a reduction in target vessel revascularization from 7.8% in the bare-metal stent group to 4.6% in the drug-eluting stent groups.
Cost of treatment
The initial cost of treatment was about $2,000 greater in the drug-eluting stent group due to the higher cost of the stents. The follow-up costs were almost identical — due to the low rate of overall major adverse cardiovascular events — but the total costs were $1,100 higher in the drug-eluting stent group.
The incremental cost-effectiveness ratio to avoid one major adverse cardiovascular event was about $21,700, while the cost for one quality-of-life year gained was $65,600 to $88,000, Pfisterer said.
For more information:
- Pfisterer ME. BASKET: Basel stent kosten-effetivitats trial. Hot line session presented at the European Society of Cardiology Congress 2005. Sept. 3-7, 2005. Stockholm.