Economic Analysis of the Use of Drug-Eluting Stents in the Perspective of the Belgian Health Care Sector
AbstractCoronary heart disease is a major cause of death and morbidity in developed countries. It is caused by narrowing of the coronary arteries and is treated by coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI) which include balloon angioplasty and stenting. A common consequence of PCI is restenosis, a re-narrowing of the blood vessel that has been opened by a vascular procedure. When restenosis occurs, the vessel has to be re-opened by PCI or CABG. The occurrence of restenosis diminishes substantially when coronary stents are used instead of the conventional balloon angioplasty. With balloon angioplasty the vessel is opened by inflation of a balloon that is removed afterwards. With stenting an artificial support device is placed in the vessel after inflation of the balloon to keep the vessel open. Although coronary stents greatly reduce the risk of restenosis, there is still some risk that the stented artery may close; especially for particularly high-risk groups such as diabetics, patients with small arteries, long lesions, etc.1,2 The possible treatment pathway after a primary PCI intervention with a BMS is represented in the upper branch of the decision tree in figure 1. Over the past decade the PCI technique to treat coronary artery disease has developed rapidly. Thanks to technical and pharmacological innovations the effectiveness and safety of coronary stent devices has gradually improved. The latest generation coronary stents are the so-called drug-eluting stents (DES), stents coated with pharmaceutical agents suppressing restenosis. The possible treatment pathway after a primary PCI intervention with a DES is represented in the lower branch of the decision tree in figure 1. As you can see, the structure of the two branches is identical. But the event rates are different. Evidence shows that rates of in-stent restenosis are lower with DES than with classic bare metal stents (BMS), and the cost of the primary PCI is different because of the higher purchase price of the DES compared with the BMS. Because of this higher purchase price, the use of BMS is still standard procedure in most European countries. In comparison to DES however, patients receiving BMS have higher costs related to revascularization. The question arising here is whether the use of DES might turn out beneficial in the long term, although it is more expensive in the short term.
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Bibliographic InfoPaper provided by University of Antwerp, Faculty of Applied Economics in its series Working Papers with number 2006012.
Length: 28 pages
Date of creation: Jun 2006
Date of revision:
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- Rosanna Tarricone & Monia Marchetti & Mark Lamotte & Lieven Annemans & Peter Jong, 2004. "What reimbursement for coronary revascularization with drug-eluting stents?," The European Journal of Health Economics, Springer, vol. 5(4), pages 309-316, November.
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