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Cost-effectiveness of drug-eluting stents in a US medicare setting : a cost-utility analysis with 3-year clinical follow-up data

Bischof, Matthias and Briel, Matthias and Bucher, Heiner C. and Nordmann, Alain. (2009) Cost-effectiveness of drug-eluting stents in a US medicare setting : a cost-utility analysis with 3-year clinical follow-up data. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, Vol. 12. pp. 649-656.

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Official URL: http://edoc.unibas.ch/dok/A6008044

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Abstract

ABSTRACT Background: There is only limited information about cost-effectiveness of drug-eluting compared with bare metal stents (BMS) over a time horizon of more than 1 year. Methods and Results: We developed a Markov model based on clinical outcome data from a meta-analysis including 17 randomized controlled trials comparing drug-eluting versus BMS with a minimum follow-up of 1 (n = 8221) and a maximum follow-up of 3 years (n = 4105) in patients with chronic coronary artery disease. Costs were obtained as reimbursement rates for diagnosis related groups from the US Centers for Medicare and Medicaid Services. All costs and effects were discounted at 3% annually. All costs are reported in US dollars of the financial year 2007. The incremental effects are 0.002 (95% confidence interval -0.039 to 0.041) quality-adjusted life-years (QALYs) for the sirolimus- and -0.001 (-0.040 to 0.038) QALYs for the paclitaxel-eluting stents (PES). The incremental costs are $2790 for the sirolimus- and $3838 for the PES. The incremental cost-effectiveness ratio is <$1,000,000 per QALY for the sirolimus-eluting stent. PES are dominated by BMS (i.e., less effective and more costly). Among various sensitivity analyses performed, the model proved to be robust. Conclusions: Our analysis from a US Medicare perspective suggests that drug-eluting stents are not cost-effective compared with BMS when implanted in unselected patients with symptomatic ischemic coronary artery disease.
Faculties and Departments:03 Faculty of Medicine > Departement Klinische Forschung > Clinical Epidemiology and Biostatistics CEB > Klinische Epidemiologie (Bucher H)
UniBasel Contributors:Bucher, Heiner C. and Nordmann, Alain J. and Briel, Matthias
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Wiley-Blackwell
ISSN:1098-3015
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:01 Feb 2013 08:46
Deposited On:01 Feb 2013 08:40

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