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Cost Effectiveness of Drug-Eluting Stents In Belgian Practice / Mattias Neyt in Pharmacoeconomics, 27(2009)4 ([04/01/2009])
[article] Cost Effectiveness of Drug-Eluting Stents In Belgian Practice : Healthcare Payer Perspective [printed text] / Mattias Neyt , Author ; Chris De Laet , Author ; Annemieke De Ridder, Author ; Hans Van Brabandt , Author . - 2009 . - 313-27.
Languages : English (eng)
in Pharmacoeconomics > 27(2009)4 [04/01/2009] . - 313-27
W 1 Serials. Periodicals
2006-08 ; Belgium ; Cost-Benefit Analysis ; Decision Support Techniques ; Drug-Eluting Stents ; Health Care Costs ; Humans ; Insurance, Health, Reimbursement ; Journal Article ; Models, Statistical ; Peer Review ; Quality-Adjusted Life Years ; R66 ; Stents
Abstract: BACKGROUND: There has been a steep increase in the number of percutaneous coronary intervention procedures performed for coronary heart disease since their introduction about 30 years ago. Recently, the use of drug-eluting stents (DES) compared with the original bare metal stents (BMS) has increased in many countries.
OBJECTIVE: To assess the cost effectiveness of DES versus BMS in a real-world setting from the Belgian healthcare payer perspective.
METHODS: We developed a decision analysis model to estimate incremental costs (year 2004 or 2007 values [depending on the underlying variable]) and effectiveness. Incremental effectiveness was calculated by combining relative benefits from published meta-analyses with real-world observations from a Belgian registry. Probabilistic modelling and sensitivity analyses were performed. The model had a 1-year time horizon. Sixteen sub groups were created based on the following characteristics: initial stent type, diabetic status, complex lesion and multi-vessel disease. Scenario analyses were performed for the influence on reinterventions and the duration of clopidogrel use. In each analysis, 1000 Monte Carlo simulations were performed.
RESULTS: The incremental costs for switching from BMS to DES are substantial (approximately euro1000), while the benefits, expressed as QALYs, are extremely small (on average
CONCLUSION: Comparing DES with BMS, no life-years are gained and small quality-of-life improvements are achieved for short periods, resulting in a high likelihood that DES are not cost effective. When there is competition for scarce resources this should be considered when deciding on the reimbursement of this technology.
Link for e-copy: https://doi.org/10.2165/00019053-200927040-00004 Format of e-copy: PDF [Requires Subscription] Record link: [article]