Ploumen Eline H, Wolcherink Martijn J Oude, Buiten Rosaly A, Pinxterhuis Tineke H, Doggen Carine J M, Schotborgh Carl E, Danse Peter W, Scholte Martijn, van Houwelingen K Gert, Zocca Paolo, Pouwels Xavier G L V, von Birgelen Clemens
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands.
Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Pharmacoecon Open. 2025 Jan;9(1):137-145. doi: 10.1007/s41669-024-00539-x. Epub 2024 Oct 29.
Evidence on health economic outcomes for percutaneous coronary intervention (PCI) comparing different contemporary drug-eluting stents (DES) with each other is scarce, as most previous randomised DES trials did not assess such aspects. This prespecified health economic evaluation of the Comparison of Biodegradable Polymer and Durable Polymer Drug-Eluting Stents in an All Comers Population (BIO-RESORT) trial aimed to compare at 3-year follow-up both health effects and costs of PCI with one of three new-generation drug-eluting stents (DES) in patients with obstructive coronary artery disease.
The randomised BIO-RESORT trial assessed in 3514 patients the ultrathin-strut biodegradable polymer Orsiro sirolimus-eluting stent (SES) and very-thin-strut Synergy everolimus-eluting (EES) stent versus the thin-strut durable polymer Resolute Integrity zotarolimus-eluting stent (ZES). In the current analysis, we used the perspective of a health insurer in the Netherlands. The main endpoints were quality-adjusted life years (QALYs), and costs for each treatment strategy. Bootstrapping with 5000 resamples was performed to capture the uncertainty of results.
Mean QALYs for each stent group were 2.566 for the SES, 2.551 for the EES, and 2.550 for the ZES. Mean costs per strategy were €14,670 for the SES, €14,946 for the EES, and €15,069 for the ZES. The SES had the highest probability of being cost-effective for every willingness-to-pay threshold up to €100,000 per QALY. Furthermore, in 79% of modelling scenarios, the SES was more effective and cheaper than ZES.
At 3-year follow-up, PCI with the SES had the highest probability of being cost-effective due to greater effectiveness and lower costs compared with the ZES and EES. These findings suggest that, due to the overall high volume of coronary stenting in clinical practice, use of this SES could result in substantial cost savings, complemented by slight additional health benefits.
比较不同当代药物洗脱支架（DES）之间经皮冠状动脉介入治疗（PCI）健康经济结果的证据很少，因为之前大多数DES随机试验未评估此类方面。这项针对“所有患者人群中可生物降解聚合物与耐用聚合物药物洗脱支架比较（BIO-RESORT）”试验的预先设定的健康经济评估旨在比较在3年随访期内，采用三种新一代药物洗脱支架（DES）之一对阻塞性冠状动脉疾病患者进行PCI治疗的健康效果和成本。
随机的BIO-RESORT试验在3514例患者中评估了超薄支撑可生物降解聚合物Orsiro西罗莫司洗脱支架（SES）、极薄支撑Synergy依维莫司洗脱（EES）支架与薄支撑耐用聚合物Resolute Integrity佐他莫司洗脱支架（ZES）。在当前分析中，我们采用了荷兰一家健康保险公司的视角。主要终点是质量调整生命年（QALY）以及每种治疗策略的成本。进行了5000次重复抽样的自举法以捕捉结果的不确定性。
SES组、EES组和ZES组的平均QALY分别为2.566、2.551和2.550。每种策略的平均成本分别为SES 14,670欧元、EES 14,946欧元和ZES 15,069欧元。对于每个高达每QALY 100,000欧元的支付意愿阈值，SES具有成本效益的概率最高。此外，在79%的建模情景中，SES比ZES更有效且成本更低。
在3年随访期，与ZES和EES相比，使用SES进行PCI因效果更好且成本更低而具有成本效益的概率最高。这些发现表明，由于临床实践中冠状动脉支架置入的总体数量很大，使用这种SES可能会大幅节省成本，并带来轻微的额外健康益处。
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