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CLINICAL RESEARCH

Cost Analysis From Two Randomized Trials of Sirolimus-Eluting Stents Versus Paclitaxel-Eluting Stents in High-Risk Patients With Coronary Artery Disease

Shpend Elezi, MD^_*, Alban Dibra, MD^_*, Ulrike Folkerts, MD^_*, Julinda Mehilli, MD^_*, Sylvia Heigl, Albert Schömig, MD and Adnan Kastrati, MD^_*,_*

^_* Deutsches Herzzentrum
1. Medizinische Klinik rechts der Isar, Technische Universität; Munich, Germany

Manuscript received November 15, 2005; revised manuscript received January 26, 2006, accepted January 29, 2006.

^_* Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum Lazarettstr. 36, 80636 Munich, Germany (Email: kastrati{at}dhm.mhn.de).

OBJECTIVES: This study sought to analyze the cost of percutaneous coronary interventions with use of sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) in patients at high risk of restenosis.

BACKGROUND: Recent studies have shown different clinical efficacy with these drug-eluting stents. Whether this difference extends on cost estimates between the 2 stents is not known.

METHODS: We included 450 patients with diabetes mellitus and in-stent restenosis from 2 randomized studies comparing SES with PES. Assigned costs for the economic evaluation were the initial hospitalization and all subsequent cardiac-related inpatient/outpatient health resources during 9 to 12 months of clinical follow-up. The economic evaluation was performed from the health insurance system's perspective.

RESULTS: There were no differences between the 2 study groups regarding mortality (p = 0.78) and myocardial infarction rates (p = 0.76). Target lesion revascularization was performed in 16 patients (7.1%) in the SES group and in 34 patients (15.1%) in the PES group (p = 0.01). Initial hospital costs were not significantly different between the 2 stents (p = 0.53). The follow-up costs were, however, different: 2,684 ± 2,072 per patient treated with SES and 4,527 ± 6,466 per patient treated with PES (p < 0.001). Total costs also differed at the end of the follow-up: 8,924 ± 3,077 per patient treated with SES and 10,903 ± 7,205 per patient treated with PES (p < 0.001).

CONCLUSIONS: In patients at high risk of restenosis, use of SES is associated with lower costs compared with PES. The cost savings are mainly due to the reduced need of repeat revascularization procedures with SES.

Abbreviations and Acronyms   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   ISAR-DESIRE = Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for In-Stent Restenosis   ISAR-DIABETES = Intracoronary Stenting and Angiographic Results: Do Diabetic Patients Derive Similar Benefit from Paclitaxel-Eluting and Sirolimus-Eluting Stents?   MACE = major adverse cardiac event   PCI = percutaneous coronary intervention   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)

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