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Contemporary Context of Drug-Eluting Stents in Brazil

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  • Steffan Frosi Stella
  • Eduardo Gehling Bertoldi
  • Carísi Anne Polanczyk

Abstract

Background . Although drug-eluting stents (DES) have been widely incorporated into clinical practice in developed countries, several countries restrict their use mainly because of their high cost and unfavorable incremental cost-effectiveness ratios (ICER). Objective . To evaluate the cost-effectiveness of DES in comparison with bare-metal stents (BMS) for treatment of coronary artery disease (CAD). Design . Markov model. Data Sources . Published literature, government database, and CAD patient cohort. Target Population . Single-vessel CAD patients. Time Horizon . One year and lifetime. Perspective . Brazilian Public Health System (SUS). Intervention . Six strategies composed of percutaneous intervention with a BMS or 1 of 5 DES (paclitaxel, sirolimus, everolimus, zotarolimus, and zotarolimus resolute). Outcome Measures . Cost for target vessel revascularization avoided and cost for quality-adjusted life year gained. Base Case Analysis . In the short-term analysis, sirolimus was the most effective and least costly among DES (ICER of I$20,642 per target vessel revascularization avoided), with all others DES dominated by sirolimus. Lifetime cumulative costs ranged from I$18,765 to I$21,400. In the base case analysis, zotarolimus resolute had the most favorable ICER among the DES (ICER I$62,761), with sirolimus, paclitaxel, and zotarolimus being absolute dominated and everolimus extended dominated by zotarolimus resolute, although all the results were above the willingness-to-pay threshold of 3 times the gross domestic product per capita (I$35,307). Sensitivity Analysis . In deterministic sensitivity analysis, results were sensitive to cost of DES, number of stents used per patient, baseline probability, and duration of stent thrombosis risk. The probabilistic sensitivity analysis demonstrated a probability of 81% for BMS being the strategy of choice, with 9% for everolimus and 9% zotarolimus resolute, at the willingness-to-pay threshold. Conclusion . DES is not a good value for money in SUS perspective, despite its benefit in reducing target vessel revascularization. Since the cost-effectiveness of DES is mainly driven by the stents’ cost difference, they should cost less than twice the BMS price to become a cost-effective alternative.

Suggested Citation

  • Steffan Frosi Stella & Eduardo Gehling Bertoldi & Carísi Anne Polanczyk, 2016. "Contemporary Context of Drug-Eluting Stents in Brazil," Medical Decision Making, , vol. 36(8), pages 1034-1042, November.
    • Handle: RePEc:sae:medema:v:36:y:2016:i:8:p:1034-1042
    DOI: 10.1177/0272989X16636054
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    References listed on IDEAS

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    1. World Bank, 2012. "World Development Indicators 2012," World Bank Publications - Books, The World Bank Group, number 6014, December.
    2. World Bank, 2013. "World Development Indicators 2013," World Bank Publications - Books, The World Bank Group, number 13191, December.
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