Florence Canoui-Poitrine (Assistance Publique - Hopitaux de Paris (AP-HP), Henri Mondor Hospital, EA 4393, Paris 12 Medical School, Créteil, France Université de Lyon, Hospices Civils de Lyon, Lyon, France) Grgoire Jeanblanc (Assistance Publique - Hopitaux de Paris (AP-HP), Henri Mondor Hospital, EA 4393, Paris 12 Medical School, Créteil, France) Corinne Alberti (AP-HP, Unit of Clinical Epidemiology, Robert Debre Hospital, Paris, France INSERM, Paris, France) Priscilla Armoogum (AP-HP, Unit of Clinical Epidemiology, Robert Debre Hospital, Paris, France) Ana Cebrian (Cordis (Johnson & Johnson), Waterloo, Belgium) Didier Carri (Rangueil Hospital, Toulouse, France) Patrick Henry (AP-HP, Lariboisiere-Saint Louis Hospital, Paris 7 Medical School, Denis Diderot University, Paris, France) Emmanuel Teiger (Assistance Publique - Hopitaux de Paris (AP-HP), Henri Mondor Hospital, EA 4393, Paris 12 Medical School, Créteil, France) Michel Slama (AP-HP, Antoine Beclere Hospital, Paris 11 Medical School, Paris Sud University, Clamart, France) Christian Spaulding (AP-HP, Cochin Hospital, Paris Descartes University, Paris, France INSERM U 907, Paris, France) Isabelle Durand-Zaleski (Assistance Publique - Hopitaux de Paris (AP-HP), Henri Mondor Hospital, EA 4393, Paris 12 Medical School, Créteil, France)
Abstract
Background:Background: Drug-eluting stents have been shown to reduce the rate of repeat revascularization after percutaneous coronary intervention for acute myocardial infarction (AMI) as compared with bare metal stents (BMS). A few studies have reported the cost effectiveness of sirolimus-eluting stents (SES) in several countries, but none in the particular setting of AMI in France. Abstract: Objectives:Objectives: To assess the cost effectiveness of SES compared with BMS in a pre-specified subgroup of French patients with AMI in the randomized, multicentre TYPHOON trial. Abstract: Methods:Methods: A prospective economic evaluation was conducted for the 337 patients in the TYPHOON trial who were enrolled in the French centres. In the TYPHOON trial, patients with AMI with ST-segment elevation less than 12 hours after the onset of chest pain were randomized to undergo percutaneous coronary intervention with either SES or BMS. Data on clinical outcomes and resource use were collected prospectively over a 1-year follow-up period (from October 2003 to October 2005). Unit costs were applied to the resource utilization data. The main outcome measure was the incremental cost-effectiveness ratio (ICER) for additional cost per target-vessel revascularization (TVR) avoided. The perspective of the study was the French healthcare system and costs were expressed in 2007 values. Abstract: Results:Results: SES significantly reduced the rate of TVR (6.6% vs 22.2% with BMS, p < 0.0001). There was no difference in the rate of death, recurrent myocardial infarction or stent thrombosis after 1 year of follow-up between the SES and BMS groups. Mean index admission costs, including the angioplasty procedure, were increased by &U20AC;1282 per patient in the SES group, mostly driven by the price of the SES. Mean follow-up costs were &U20AC;140 per patient lower in the SES group. Mean aggregate 1-year costs showed a &U20AC;1142 per-patient increase in the SES group compared with the BMS group. The ICER was &U20AC;7321 per TVR avoided. Abstract: Conclusion:Conclusion: In this pre-specified subgroup analysis of the TYPHOON trial, the use of SES in patients with AMI with ST-segment elevation less than 12 hours after the onset of chest pain reduced the rate of TVR compared with BMS. However, SES had a debatable ICER for the payer if it was based only on the specific benefit of TVR avoided.
Download Info
To download:
If you experience problems downloading a file, check if you have the
proper application to
view it first. Information about this may be contained
in the File-Format links below. In case of further problems read
the IDEAS help
page. Note that these files are not on the IDEAS
site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
For technical questions regarding this item, or to correct its listing, contact: (Remco Bouckaert).
Related research
Keywords:
Find related papers by JEL classification: C - Mathematical and Quantitative Methods D - Microeconomics I - Health, Education, and Welfare Z - Other Special Topics I1 - Health, Education, and Welfare - - Health I19 - Health, Education, and Welfare - - Health - - - Other I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets