Polymer-Free Drug-Coated Coronary Stents Are Cost-Effective in Patients at High Bleeding Risk: Economic Evaluation of the LEADERS FREE Trial.

Abstract

AIMS:

In patients at high risk of bleeding who undergo PCI the biolimus A9 polymer-free drug coated stent (DCS) has superior efficacy and safety compared to a bare metal stent (BMS). We estimated the cost effectiveness of DCS vs. BMS.

METHODS AND RESULTS:

The Leaders FREE-based economic evaluation estimated service use and quality of life data collected prospectively. The entire trial population was analysed using cost-weights from England, France, Germany, Italy, Scotland and Spain. Country-specific QALYs were derived from EQ-5D scores. We estimated cost per event averted and per QALY gained. DCS use resulted in -0.095 cardiac deaths, target vessel MI, stent thrombosis and revascularization per patient (0.152 vs. 0.237;p<0.001). One-year QALYs were non-significantly higher in the DCS group. Total costs for the index admission were similar between groups. One-year costs using cost-weights from each of the 6 countries, including the additional €300 per DCS stent, ranged from €4,664-8,593 for DCS and €4,845-9,742 for BMS and were lower in the DCS group (England:€-428, France:€-137, Germany:€-33, Italy:€-522, Scotland:€-298, Spain:€-854).

CONCLUSIONS:

The probability that DCS dominated BMS was >50% in all countries. At a threshold of €10,000 per event averted DCS had a 98% probability of being cost-effective in all 6 countries.

• Authors: Antoine Filipovic-Pierucci, Isabelle Durand-Zaleski, Thibault Butel, Samantha Greene, Thomas Hovasse, Andres Iñiguez, Marco Stefano Nazzaro, Keith G Oldroyd, Suneel Talwar, Gert Richardt, Ute Windhovel, Philip Urban, Marie-Claude Morice
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 13 Issue 14 Pg. 1688-1695 (02 20 2018) ISSN: 1969-6213 [Electronic] France
• PMID: 28891471 (Publication Type: Journal Article)

Chemical References

• Polymers

Topics

• Cost-Benefit Analysis
• Drug-Eluting Stents (economics)
• Health Care Costs
• Hemorrhage (etiology)
• Humans
• Percutaneous Coronary Intervention (adverse effects, economics)
• Polymers
• Probability
• Prospective Studies
• Quality-Adjusted Life Years