Yonsei Med J.  2014 Nov;55(6):1533-1541. 10.3349/ymj.2014.55.6.1533.

Cost-Effectiveness of Drug-Eluting vs. Bare-Metal Stents in Patients with Coronary Artery Disease from the Korean National Health Insurance Database

• Lee S
• Baek K
• Chun K

• KMID: 2070200
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1533

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.

Keyword

Incremental cost effectiveness ratio; drug-eluting stents; bare-metal stents; stent implantation

MeSH Terms

Aged
*Angioplasty, Balloon, Coronary
Asian Continental Ancestry Group/statistics & numerical data
Coronary Artery Disease/etiology/*therapy
Cost-Benefit Analysis
Drug-Eluting Stents/economics
Female
Humans
Immunosuppressive Agents/administration & dosage/*economics
Male
Middle Aged
Myocardial Infarction/therapy
National Health Programs/*statistics & numerical data
Paclitaxel/administration & dosage
Republic of Korea/epidemiology
Retrospective Studies
Risk
Sirolimus/administration & dosage
Stents/adverse effects/*economics
Treatment Outcome
Immunosuppressive Agents
Paclitaxel
Sirolimus

Figure

• 

  Fig. 1 Cumulative survival rate in patients with drug-eluting stents and bare-metal stents. (A) Coronary artery disease patients. (B) Myocardial infarction patients. (C) Low-risk and high-risk coronary artery disease patients. (D) Low-risk and high-risk myocardial infarction patients. DES, drug-eluting stent; BMS, bare-metal stent; CAD, coronary artery disease; MI, myocardial infarction.

• 

  Fig. 2 Cumulative re-stenting rate in patients with drug-eluting stents and bare-metal stents. (A) Coronary artery disease patients. (B) Myocardial infarction patients. (C) Low-risk and high-risk coronary artery disease patients. (D) Low-risk and high-risk myocardial infarction patients (***p<0.001). DES, drug-eluting stent; BMS, bare-metal stent; CAD, coronary artery disease; MI, myocardial infarction.

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