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Higher upfront cost of DES vs. BMS offset at 3 years
Schafer P. Circ Cardiovasc Qual Outcomes. 2011;doi:10.1161/circoutcomes.110.960187.
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Due to lower rates of target vessel revascularization, the higher initial cost of drug-eluting stents compared with bare metal stents was found to be entirely offset at 3 years in a recent analysis.
The study included patients from the Wake Forest University Baptist Medical Center who underwent revascularization with a bare metal stent (BMS; n=1,147) before the availability of drug-eluting stents (DES) or with a DES (n=1,247) from 2002 to 2005. Researchers determined costs for index stenting, clopidogrel (Plavix, Sanofi-Aventis) use and target vessel revascularization. Baseline characteristics of the two groups were similar.
For the DES group, the index cost of the procedure was noticeably higher, between $1,846 per patient when compared with the BMS group. However, this was offset at 3 years, as rates of target vessel revascularization were substantially lower in the DES group (15.2 vs. 24.1 per 100 patients), leading to target vessel revascularization-related costs being $2,065 less per patient. Factoring in the cost of clopidogrel, researchers found that the incremental cost-effectiveness ratio per target vessel revascularization avoided with DES was $4,731 at 1 year, $4,703 at 2 years, and $6,379 at 3 years.
These findings, they wrote, “provide support for the continued use of DES in today’s health care environment and also demonstrate the importance of determining the optimal duration of dual antiplatelet therapy after DES implantation to more accurately define the long-term value of this technology.”
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