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

Cost Analysis From Two Randomized Trials of Sirolimus-Eluting Stents Versus Paclitaxel-Eluting Stents in High-Risk Patients With Coronary Artery Disease Shpend Elezi, Alban Dibra, Ulrike Folkerts, Julinda Mehilli, Sylvia Heigl, Albert Schömig, Adnan Kastrati We evaluated the costs of percutaneous coronary interventions with implantation of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in 450 patients with diabetes mellitus and in-stent restenosis from 2 randomized studies that compared these drug-eluting stents. Although initial hospital costs did not differ between the 2 stents (p = 0.53), follow-up costs were different (2,684 ± 2,072 € per patient treated with SES and 4,527 ± 6,466 € per patient treated with PES; p < 0.001). In patients at high risk of restenosis, SES are associated with lower costs than PES, mainly because of the reduced need for repeat revascularization procedures (7.1% vs. 15.1%, respectively; p = 0.01). 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. 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. 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. 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). In patients at high risk of restenosis, use of SES is associated with lower costs compared with PES.