Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ - Brazil.
Arq Bras Cardiol. 2010 Mar;94(3):286-92, 306-12. doi: 10.1590/s0066-782x2010000300005.
There is a scarcity of cost-effectiveness analyses in the national literature comparing drug-eluting stents (DES) with bare-metal stents (BMS), at late follow-up.
To estimate the Incremental Cost-Effectiveness Ratio (ICER) between DES and BMS in uniarterial coronariopathy.
217 patients (130 DES and 87 BMS), with 48 months of follow-up (mean = 26 months) were assessed.
cost per prevented restenosis, with effectiveness being defined as the decrease in major events. The analytical model of decision was based on the study by Polanczyk et al. The direct costs were those used directly in the interventions.
The sample was homogenous for age and sex. The DES was more used in diabetic patients: 59 (45.4%) vs 16 (18.4%)(p<0.0001) and with a history of coronary artery disease (CAD): 53 (40.7%) vs 13 (14.9%)(p<0.0001). The BMS was more used in simple lesions, but with worse ventricular function. The DES were implanted preferentially in proximal lesions: (p=0.0428) and the BMS in the mid-third (p=0.0001). Event-free survival: DES = 118 (90.8%) vs BMS=74 (85.0%) (p=0.19); Angina: DES=9 (6.9%) vs BMS=9 (10.3%) (NS): Clinical restenosis: DES=3 (2.3%) vs BMS=10 (10.3%) (p=0.0253). Cardiac deaths: 2 (1.5%) in DES and 3 (3.5%) in BMS (NS).
the tree of decision was modeled based on restenosis. The net benefit for the DES needed an increment of R$7,238.16. The ICER was R$131,647.84 per prevented restenosis (above the WHO threshold).
The DES was used in more complex lesions. The clinical results were similar. The restenosis rate was higher in the BMS group. The DES was a non-cost-effective strategy.
在晚期随访的国家文献中，很少有比较药物洗脱支架（DES）和裸金属支架（BMS）的成本效益分析。
估计单动脉冠心病中 DES 和 BMS 的增量成本效益比（ICER）。
评估了 217 名患者（DES 组 130 例，BMS 组 87 例），随访时间为 48 个月（平均 26 个月）。
每例预防再狭窄的成本，有效性定义为主要事件的减少。决策分析模型基于 Polanczyk 等人的研究。直接成本是指直接用于干预的成本。
该样本在年龄和性别上是同质的。DES 在糖尿病患者中的使用率更高：59 例（45.4%）比 16 例（18.4%）（p<0.0001），DES 在有冠心病史的患者中更常用：53 例（40.7%）比 13 例（14.9%）（p<0.0001）。BMS 更常用于简单病变，但心室功能较差。DES 优先植入近端病变：（p=0.0428），BMS 植入中段：（p=0.0001）。无事件生存率：DES=118（90.8%）比 BMS=74（85.0%）（p=0.19）；心绞痛：DES=9（6.9%）比 BMS=9（10.3%）（无统计学差异）；临床再狭窄：DES=3（2.3%）比 BMS=10（10.3%）（p=0.0253）。DES 组心脏死亡 2 例（1.5%），BMS 组 3 例（3.5%）（无统计学差异）。
决策树基于再狭窄建模。DES 的净效益需要增加 R$7,238.16。每例预防再狭窄的 ICER 为 R$131,647.84（高于世卫组织阈值）。
DES 用于更复杂的病变。临床结果相似。BMS 组的再狭窄率较高。DES 是一种非成本效益策略。
