IDEAS home Printed from https://ideas.repec.org/a/spr/aphecp/v10y2012i4p235-248.html

Cost Effectiveness of Drug-Eluting Stents in Acute Myocardial Infarction Patients in Germany

Author

Listed:
  • Michael Bäumler

  • Tom Stargardt
  • Jonas Schreyögg
  • Reinhard Busse

Abstract

Background: The high number of patients with acute myocardial infarction (AMI) has facilitated greater research, resulting in the development of innovative medical devices. So far, results from economic evaluations that compared drug-eluting stents (DES) and bare-metal stents (BMS) have not shown clear evidence that one intervention is more cost effective than the other. Objective: The aim of this study was to measure the cost effectiveness of DES compared with BMS in routine care. Methods: We used administrative data from a large German sickness fund to compare the costs and effectiveness of DES and BMS in patients with AMI. Patients with hospital admission after AMI in 2004 and 2005 were followed up for 1 year after hospital discharge. The cost of treatment and survival after 365 days were compared for patients treated with DES and BMS. We adjusted for covariates defined according to the Ontario Acute Myocardial Infarction Mortality Prediction Rules using propensity score matching. After matching, we calculated incremental cost-effectiveness ratios (ICERs) by (i) using sample means based on bootstrapping procedures and (ii) estimating generalized linear mixed models for costs and survival. Results: After propensity score matching, the sample included 719 patients treated with DES and 719 patients treated with BMS. A comparison of sample means resulted in average costs of €12 714 and €11714 for DES and BMS, respectively, in 2005 German euros. Difference in 365-day survival was not statistically significant (700 patients with DES and 701 with BMS). The ICER of DES versus BMS was −€718 709 per life saved. Bootstrapping resulted in DES being dominated by BMS in 54.5% of replications and DES being a dominant strategy in 2.7% of replications. Results from regression models and sensitivity analyses confirm these results. Conclusion: Treatment with DES after admission with AMI is less cost effective than treatment with BMS. Our results are in line with other cost-effectiveness analyses that used administrative data, i.e. under routine care conditions. However, our results do not preclude that DES may be cost effective in specific patient subgroups. Copyright Springer International Publishing AG 2012

Suggested Citation

  • Michael Bäumler & Tom Stargardt & Jonas Schreyögg & Reinhard Busse, 2012. "Cost Effectiveness of Drug-Eluting Stents in Acute Myocardial Infarction Patients in Germany," Applied Health Economics and Health Policy, Springer, vol. 10(4), pages 235-248, July.
    • Handle: RePEc:spr:aphecp:v:10:y:2012:i:4:p:235-248
    DOI: 10.2165/11597340-000000000-00000
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.2165/11597340-000000000-00000
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.2165/11597340-000000000-00000?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Cutler, David, 2007. "The Lifetime Costs and Benefits of Medical Technology," Scholarly Articles 2643640, Harvard University Department of Economics.
    2. Cutler, David M., 2007. "The lifetime costs and benefits of medical technology," Journal of Health Economics, Elsevier, vol. 26(6), pages 1081-1100, December.
    3. Mattias Neyt & Chris Laet & Annemieke Ridder & Hans Brabandt, 2009. "Cost Effectiveness of Drug-Eluting Stents In Belgian Practice," PharmacoEconomics, Springer, vol. 27(4), pages 313-327, April.
    4. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann & Reinhard Busse, 2006. "Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries," Health Care Management Science, Springer, vol. 9(3), pages 215-223, August.
    5. Dennis D. Boos & Leonard A. Stefanski & Yujun Wu, 2009. "Fast FSR Variable Selection with Applications to Clinical Trials," Biometrics, The International Biometric Society, vol. 65(3), pages 692-700, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Tamara Schmid, 2015. "Costs of treating cardiovascular events in Germany: a systematic literature review," Health Economics Review, Springer, vol. 5(1), pages 1-11, December.
    2. James Lomas & Miqdad Asaria & Laura Bojke & Chris P. Gale & Gerry Richardson & Simon Walker, 2019. "Correction to: Which Costs Matter? Costs Included in Economic Evaluation and their Impact on Decision Uncertainty for Stable Coronary Artery Disease," PharmacoEconomics - Open, Springer, vol. 3(2), pages 277-277, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Schreyögg, Jonas & Bäumler, Michael & Busse, Reinhard, 2010. "Erratum to "Balancing adoption and affordability of medical devices in Europe" [Health Policy 92 (2009) 218-224]," Health Policy, Elsevier, vol. 94(1), pages 90-90, January.
    2. Margaret Oppenheimer & Helen LaVan & William Martin, 2015. "A Framework for Understanding Ethical and Efficiency Issues in Pharmaceutical Intellectual Property Litigation," Journal of Business Ethics, Springer, vol. 132(3), pages 505-524, December.
    3. Moreno Gigi & van Eijndhoven Emma & Benner Jennifer & Sullivan Jeffrey, 2017. "The Long-Term Impact of Price Controls in Medicare Part D," Forum for Health Economics & Policy, De Gruyter, vol. 20(2), pages 1-56, December.
    4. Joseph J. Doyle, 2011. "Returns to Local-Area Health Care Spending: Evidence from Health Shocks to Patients Far from Home," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 221-243, July.
    5. N. Meltem Daysal & Mircea Trandafir & Reyn van Ewijk, 2015. "Saving Lives at Birth: The Impact of Home Births on Infant Outcomes," American Economic Journal: Applied Economics, American Economic Association, vol. 7(3), pages 28-50, July.
    6. Li, Jing, 2014. "The influence of state policy and proximity to medical services on health outcomes," Journal of Urban Economics, Elsevier, vol. 80(C), pages 97-109.
    7. Dokow, Elad & Luque, Jaime, 2019. "Provision of local public goods in mixed income communities," Journal of Housing Economics, Elsevier, vol. 45(C), pages 1-1.
    8. Damien Bricard & Zeynep Or, 2018. "Does an Early Primary Care Follow-up after Discharge Reduce Readmissions for Heart Failure Patients?," Working Papers DT73, IRDES institut for research and information in health economics, revised Mar 2018.
    9. Frankovic, Ivan & Kuhn, Michael & Wrzaczek, Stefan, 2017. "Medical progress, demand for health care, and economic performance," ECON WPS - Working Papers in Economic Theory and Policy 08/2017, TU Wien, Institute of Statistics and Mathematical Methods in Economics, Economics Research Unit.
    10. Jakub Červený & Jan C. van Ours, 2025. "Long-term returns to local health-care spending," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(2), pages 153-182, March.
    11. Alice Sanwald & Thomas Schober, 2014. "Follow your Heart: Survival chances and costs after Heart Attacks – An instrumental Variable Approach," CDL Aging, Health, Labor working papers 1503, The Christian Doppler (CD) Laboratory Aging, Health, and the Labor Market, Johannes Kepler University Linz, Austria.
    12. Maffioli, Elisa M., 2021. "The political economy of health epidemics: Evidence from the Ebola outbreak," Journal of Development Economics, Elsevier, vol. 151(C).
    13. Corinna Hentschker & Ansgar Wübker, 2020. "Quasi-experimental evidence on the effectiveness of heart attack treatment in Germany," Applied Economics, Taylor & Francis Journals, vol. 52(50), pages 5531-5545, October.
    14. Sarah Miller & Petra Persson & Maya Rossin-Slater & Laura R. Wherry, 2025. "The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries," NBER Working Papers 34556, National Bureau of Economic Research, Inc.
    15. Liran Einav & Amy Finkelstein & Neale Mahoney, 2025. "Producing Health: Measuring Value Added of Nursing Homes," Econometrica, Econometric Society, vol. 93(4), pages 1225-1264, July.
    16. Bryan P. Schmutz & Rexford E. Santerre, 2013. "Examining The Link Between Cash Flow, Market Value, And Research And Development Investment Spending In The Medical Device Industry," Health Economics, John Wiley & Sons, Ltd., vol. 22(2), pages 157-167, February.
    17. de Meijer, Claudine & O’Donnell, Owen & Koopmanschap, Marc & van Doorslaer, Eddy, 2013. "Health expenditure growth: Looking beyond the average through decomposition of the full distribution," Journal of Health Economics, Elsevier, vol. 32(1), pages 88-105.
    18. Ivan Frankovic & Michael Kuhn & Stefan Wrzaczek, 2020. "On the Anatomy of Medical Progress Within an Overlapping Generations Economy," De Economist, Springer, vol. 168(2), pages 215-257, June.
    19. Vasudeva N. R. Murthy & Natalya Ketenci, 2017. "Is technology still a major driver of health expenditure in the United States? Evidence from cointegration analysis with multiple structural breaks," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 29-50, March.
    20. Bhalotra, Sonia R. & Nunes, Letícia & Rocha, Rudi, 2020. "Urgent Care Centers, Hospital Performance and Population Health," IZA Discussion Papers 13992, IZA Network @ LISER.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:aphecp:v:10:y:2012:i:4:p:235-248. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.