Projected Health and Economic Benefits of the Use of Sirolimus-eluting Coronary Stents

Despite remarkable technological progress in interventional cardiology, the success of percutaneous coronary intervention (PCI) remains limited by in-stent restenosis. Recent trials of sirolimuseluting stents have shown promising results regarding this complication. We estimated the potential health-economic benefits of sirolimuseluting stents. A decision-analytic model was developed from a payor’s perspective to estimate the cost effectiveness of sirolimus-eluting stents compared with standard bare-metal stents in PCI, as well as with coronary artery bypass graft (CABG) surgery for a 500 000-member healthcare plan. The model input health plan–specific data for volume and reimbursement rates for PCI and CABG; the results of a randomized trial comparing the 2 types of stents were used as a reference. A mean of 1.4 stents per patient for comparisons with PCI, and 2.8 stents per patient for comparisons with CABG in multivessel cases, and an incremental cost of $2000 per stent for the drug-eluting versus the bare-metal stent were assumed. Supposing that patients at high risk for restenosis are selected first, the use of a sirolimuseluting stent rather than a standard stent in 49% of current PCIs was associated with a total cost increase of $295 for the plan and 202 fewer hospital days. If all patients who currently receive a standard stent received a sirolimus-eluting stent, an incremental cost of $568 823 for the health plan and 284 fewer hospital days were calculated. If all patients currently eligible to receive a standard stent, plus 39% of patients with multivessel disease who are typically referred for CABG surgery, were treated instead with a sirolimus-eluting stent, the estimated savings for the health plan totaled $2993, and hospital days were reduced by 745 days. In this model, substituting a sirolimus-eluting stent for a bare-metal stent in patients at high risk for in-stent restenosis was cost-neutral and reduced the incidence of repeated hospitalization. Sirolimus-eluting stents offer substantial cost savings for a health plan if their use can be expanded to a modest subset of patients currently referred for CABG surgery. (Adv Stud Med. 2003;3(6D):S602-S611)