Cost-effectiveness of the Second-generation Everolimus-eluting Stent Compared to the First-genereation Paclitaxel-eluting Stent in Patients Undergoing Percutaneous Coronary Intervention in Daily Practice

Objectives: To examine the cost-effectiveness of the second-generation everolimus-eluting stent (EES) compared to the first-generation paclitaxel-eluting stent (PES) in patients undergoing percutaneous coronary intervention (PCI) in daily practice. Methods: The cost-effectiveness analysis was based on data from the TAXUS Stent Evaluated at Rotterdam Cardiology Hospital (T-SEARCH) and XIENCE Stent Evaluated at Rotterdam Cardiology Hospital (X-SEARCH) registries. The primary effectiveness measure was major adverse cardiac events (MACE)-free survival, in which the composite of MACE consisted of death, myocardial infarction (MI), repeat PCI and coronary artery bypass grafting (CABG). The costs were assessed in 2012 Euros (€) and limited to direct medical costs. A bootstrap simulation was used to estimate the uncertainty on the results of MACEfree survival and direct medical costs. An additional analysis was performed to evaluate the impact of patient characteristics on the study results. Results: At the end of the two year follow-up period, the use of EES was associated with an increased MACE-free survival of 0.076 years and cost savings of €498.34. The probability that EES maintained dominant over PES was confirmed in 76.0% of the bootstrap simulations. The study results were affected by patient characteristics. Conclusion: EES has proven to be dominant over PES by improving the clinical and economic benefits of PCI in daily practice, even though EES seemed to be worse off based on the patient characteristics.