Müller-Riemenschneider F, Reinhold T, Willich S N
Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Deutschland.
Herz. 2011 May;36(3):254-61. doi: 10.1007/s00059-011-3463-2.
The objective of the present review was to investigate the cost-effectiveness of second-generation drug-eluting stents (DES) compared to bare metal stents (BMS) as well as to first-generation DES.
A structured literature review in MEDLINE was conducted to identify all studies investigating the cost-effectiveness of second-generation DES published up to December 2010. Pre-specified selection criteria were applied to identify relevant studies. Standardized data extraction was performed to summarize clinical, economic, and cost-effectiveness outcomes of these studies.
Of only five studies which met all selection criteria from the US, UK, and Spain, three investigated the cost-effectiveness of the zotarolimus-coated Endeavor stent (ZES) compared to BMS, and two studies the ZES with first-generation DES.
In summary, there is currently a lack of evidence with regard to the cost-effectiveness of second-generation DES, especially in Germany. However, studies from other countries provide some evidence that second-generation DES appear to generally not be cost-effective compared to BMS. Also, there is no conclusive evidence of cost-effectiveness compared to first-generation DES. Moreover, there are currently no studies investigating the cost-effectiveness of the Everolimus-coated Xience V stent. Methodologically rigorous economic evaluations addressing these issues within the context of the German health care system are therefore urgently required.
本综述的目的是研究第二代药物洗脱支架（DES）与裸金属支架（BMS）以及第一代DES相比的成本效益。
在MEDLINE上进行了结构化文献综述，以识别截至2010年12月发表的所有研究第二代DES成本效益的研究。应用预先指定的选择标准来识别相关研究。进行标准化数据提取以总结这些研究的临床、经济和成本效益结果。
在美国、英国和西班牙仅有的五项符合所有选择标准的研究中，三项研究了佐他莫司涂层的安珂支架（ZES）与BMS相比的成本效益，两项研究了ZES与第一代DES相比的成本效益。
总之，目前缺乏关于第二代DES成本效益的证据，尤其是在德国。然而，其他国家的研究提供了一些证据，表明与BMS相比，第二代DES似乎总体上不具有成本效益。此外，与第一代DES相比，也没有确凿的成本效益证据。此外，目前没有研究调查依维莫司涂层的Xience V支架的成本效益。因此，迫切需要在德国医疗保健系统的背景下进行方法严谨的经济评估来解决这些问题。
