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
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
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DOI：
10.1161/01.cir.0000136821.99814.43
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发表时间：
2004-08-03
期刊：
影响因子：
37.8
通讯作者：
Kuntz, RE
中科院分区：
文献类型：
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作者：
Cohen, DJ;Bakhai, A;Kuntz, RE
背景-最近，西罗莫司洗脱支架（SES）与裸金属支架（BMS）植入相比，已被证明可显著降低血管造影和临床再狭窄的风险。然而，这一战略的总体成本效益是unknown.Methods和结果-2001年2月至8月，1058例复杂的冠状动脉狭窄患者参加了SIRIUS试验，并随机经皮冠状动脉血运重建与SES或BMS。在1年的随访期内，对所有患者的临床结局、资源使用和成本进行前瞻性评估。最初的住院费用增加了2881美元，每名患者与SES。在1年随访期内，使用SES导致重复血运重建的需求大幅减少，包括重复经皮冠状动脉介入治疗和搭桥手术。尽管SES患者的随访费用降低了2571美元，但1年总费用仍高出309美元。SES的增量成本-效果比为每避免重复血运重建事件1650美元，或每获得质量调整后的生命年27540美元，与其他公认的医疗干预措施相比，这些值是合理的。根据最新的治疗假设，关于可用的支架长度和抗血小板治疗的持续时间，使用SES预计将减少总1年的成本相比BMSs.Conclusions -虽然使用SES是不节省成本相比，BMS植入，复杂的冠状动脉狭窄的患者接受经皮冠状动脉介入治疗，他们的使用似乎是合理的成本效益的背景下，美国的医疗保健系统。
Background - Recently, sirolimus-eluting stents (SESs) have been shown to dramatically reduce the risk of angiographic and clinical restenosis compared with bare metal stent (BMS) implantation. However, the overall cost-effectiveness of this strategy is unknown.Methods and Results - Between February and August 2001, 1058 patients with complex coronary stenoses were enrolled in the SIRIUS trial and randomized to percutaneous coronary revascularization with either a SES or BMS. Clinical outcomes, resource use, and costs were assessed prospectively for all patients over a 1-year follow-up period. Initial hospital costs were increased by $2881 per patient with SESs. Over the 1-year follow-up period, use of SESs led to substantial reductions in the need for repeat revascularization, including repeat percutaneous coronary intervention and bypass surgery. Although follow-up costs were reduced by $2571 per patient with SESs, aggregate 1-year costs remained $309 per patient higher. The incremental cost-effectiveness ratio for SES was $1650 per repeat revascularization event avoided or $27 540 per quality-adjusted year of life gained, values that compare reasonably with other accepted medical interventions. Under updated treatment assumptions regarding available stent lengths and duration of antiplatelet therapy, use of SESs was projected to reduce total 1-year costs compared with BMSs.Conclusions - Although use of SESs was not cost-saving compared with BMS implantation, for patients undergoing percutaneous coronary intervention of complex coronary stenoses, their use appears to be reasonably cost-effective within the context of the US healthcare system.