Cost-effectiveness of Drug-eluting Vs. Bare-metal Stents in Patients with Coronary Artery Disease from the Korean National Health Insurance Database

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2014 Oct 18

PMID 25323889

Citations 3

Authors

Soojin Lee

KyungWon Baek

Kihong Chun

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to evaluate the cost-effectiveness of the use of drug-eluting stents (DESs), as compared with bare-metal stents (BMSs) in Korea.

Materials And Methods: A retrospective cohort study was conducted between January 2000 and December 2007. Subjects were stent-treated for the first time between 2004 and 2005, with four years of follow-up (2004-2007) (n=43674). The incremental cost-effectiveness ratio (ICER) was used to calculate the costs of DESs compared with BMSs among patients with coronary artery disease (CAD). Cost-effectiveness was assessed with effectiveness defined as a reduction in major adverse cardiac events after six months and after one, two, three, and four years.

Results: The total costs of a DESs were 674108 Korean won (KRW) higher than that of a BMSs at the end of the follow-up; 13635 thousand KRW per patient treated with DESs and 12960 thousand KRW per patient treated with BMSs. The ICER was 256315 per KRW/death avoided and 293090 per KRW/re-stenting avoided among the CAD patients at the end of the follow-up.

Conclusion: The ICER for the high-risk patients was lower than that for the low-risk patients. The use of DESs is clinically more useful than the use of BMSs for CAD and myocardial infarction patients, especially for those considered to be high-risk patients in Korea.

Citing Articles

Prevalence and incidence of atherosclerotic cardiovascular disease and its risk factors in Korea: a nationwide population-based study.

Kim H, Kim S, Han S, Rane P, Fox K, Qian Y BMC Public Health. 2019; 19(1):1112.

PMID: 31412823 PMC: 6694551. DOI: 10.1186/s12889-019-7439-0.

Therapeutic Hypothermia for Cardioprotection in Acute Myocardial Infarction.

Kang I, Fumiaki I, Pyun W Yonsei Med J. 2016; 57(2):291-7.

PMID: 26847278 PMC: 4740518. DOI: 10.3349/ymj.2016.57.2.291.

Changes in the Practice of Coronary Revascularization between 2006 and 2010 in the Republic of Korea.

Choi Y, Kim J, Cho S, Cho J, Sohn J, Cho S Yonsei Med J. 2015; 56(4):895-903.

PMID: 26069109 PMC: 4479855. DOI: 10.3349/ymj.2015.56.4.895.

References

Morice M, Colombo A, Meier B, Serruys P, Tamburino C, Guagliumi G . Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the REALITY trial: a randomized controlled trial. JAMA. 2006; 295(8):895-904. DOI: 10.1001/jama.295.8.895. View

Lee K, Lee S . Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea. Health Policy. 2006; 81(2-3):300-8. DOI: 10.1016/j.healthpol.2006.05.019. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Jeong M, Kim S, Ahn Y, Cho J, Park J, Na K . Predictive factors for the second restenosis after coronary interventions. Catheter Cardiovasc Interv. 2000; 50(1):34-9. DOI: 10.1002/(sici)1522-726x(200005)50:1<34::aid-ccd7>3.0.co;2-l. View

Serruys P, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G . A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994; 331(8):489-95. DOI: 10.1056/NEJM199408253310801. View

Costa Jr J, Abizaid A, Feres F, Costa R, Seixas A, Maia F . EXCELLA First-in-Man (FIM) study: safety and efficacy of novolimus-eluting stent in de novo coronary lesions. EuroIntervention. 2008; 4(1):53-8. DOI: 10.4244/eijv4i1a10. View

Fischman D, Leon M, Baim D, Schatz R, Savage M, Penn I . A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994; 331(8):496-501. DOI: 10.1056/NEJM199408253310802. View

Bakhai A, Stone G, Mahoney E, Lavelle T, Shi C, Berezin R . Cost effectiveness of paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization: results from the TAXUS-IV Trial. J Am Coll Cardiol. 2006; 48(2):253-61. DOI: 10.1016/j.jacc.2006.02.063. View

Rocca H, Kaiser C, Bernheim A, Zellweger M, Jeger R, Buser P . Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitäts Trial (BASKET): an 18-month analysis. Lancet. 2007; 370(9598):1552-9. DOI: 10.1016/S0140-6736(07)61660-2. View

10.

Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali W . New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004; 57(12):1288-94. DOI: 10.1016/j.jclinepi.2004.03.012. View

11.

Cohen D, Bakhai A, Shi C, Githiora L, Lavelle T, Berezin R . Cost-effectiveness of sirolimus-eluting stents for treatment of complex coronary stenoses: results from the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) trial. Circulation. 2004; 110(5):508-14. DOI: 10.1161/01.CIR.0000136821.99814.43. View

12.

Kwon S . Payment system reform for health care providers in Korea. Health Policy Plan. 2003; 18(1):84-92. DOI: 10.1093/heapol/18.1.84. View

13.

Kaiser C, Rocca H, Buser P, Bonetti P, Osswald S, Linka A . Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a real-world setting: randomised Basel Stent Kosten Effektivitäts Trial (BASKET). Lancet. 2005; 366(9489):921-9. DOI: 10.1016/S0140-6736(05)67221-2. View

14.

Hoffmann R, Mintz G . Coronary in-stent restenosis - predictors, treatment and prevention. Eur Heart J. 2000; 21(21):1739-49. DOI: 10.1053/euhj.2000.2153. View

15.

Stone G, Grines C, Cox D, Garcia E, Tcheng J, Griffin J . Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med. 2002; 346(13):957-66. DOI: 10.1056/NEJMoa013404. View

16.

van Hout B, Serruys P, Lemos P, van den Brand M, van Es G, Lindeboom W . One year cost effectiveness of sirolimus eluting stents compared with bare metal stents in the treatment of single native de novo coronary lesions: an analysis from the RAVEL trial. Heart. 2005; 91(4):507-12. PMC: 1768841. DOI: 10.1136/hrt.2004.034454. View

17.

Babapulle M, Joseph L, Belisle P, Brophy J, Eisenberg M . A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet. 2004; 364(9434):583-91. DOI: 10.1016/S0140-6736(04)16850-5. View