| Autor: |
Reynolds, Matthew R., Pinto, Duane S., Shi, Chunxue, Walczak, Joshua, Berezin, Ronna, Holmes, David R., Cohen, David J., Holmes, David R Jr |
| Předmět: |
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| Zdroj: |
American Heart Journal; Dec2007, Vol. 154 Issue 6, p1221-1227, 7p |
| Abstrakt: |
Background: Sirolimus-eluting stents (SESs) were recently shown to be superior to vascular brachytherapy for the treatment of restenosis within a bare metal stent. No economic comparison of these alternative strategies has yet been reported.Methods: We conducted a prospective health economic study involving all patients randomized to SES (n = 259) or brachytherapy (n = 125) in the SISR trial. Procedural, hospital, and outpatient costs, as well as physician fees, were estimated through 12 months based on measured resource use and itemized hospital bills. Cost-effectiveness was assessed in terms of the cost per repeat revascularization avoided, cost per major adverse cardiac event avoided, and cost per event-free patient.Results: Although initial device costs were approximately $1100/patient higher in the SES group, this was offset by higher physician fees associated with brachytherapy, such that initial hospitalization costs were similar for the 2 groups. Because SES significantly reduced repeat revascularization procedures and major adverse cardiac event compared with brachytherapy during follow-up, cumulative 12-month costs were significantly lower in the SES group ($16,482 vs $19,435, mean difference -$2953, 95% CI -$5470 to -$792). Sirolimus-eluting stenting was thus both more effective and less expensive than brachytherapy, as confirmed in >98% of bootstrap replications for each of the cost-effectiveness outcomes.Conclusions: Compared with vascular brachytherapy, SES is an economically dominant strategy for the treatment of in-stent restenosis. [ABSTRACT FROM AUTHOR] |
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