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Abstract

Economic Evaluation of the Use of Drug-Eluting Stents versus Bare-Metal Stents in Adults with Ischemic Cardiomyopathy Requiring Angioplasty

VOLUME 67 - NUMBER 4 / July - August (Original articles)

Belinda González-Díaz, Department of Hemodynamics, Hospital de Cardiología, Unidad Médica de Alta Especialidad, CMN-SXXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México
Juan Garduño-Espinosa, Subdirection of Research, Hospital Infantil de México Federico Gómez, México, D.F., Mexico
Guillermo Salinas-Escudero, Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, México, D.F., México
Alfonso Reyes-López, Subdirection of Research and Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, México, D.F., Mexico
Víctor Granados-García, Department for Epidemiological Investigation and Health Services, Aging Area, CMN-SXXI, IMSS, México, D.F., México

Background: The value of drug-eluting stents in preventing cardiovascular events has not been investigated in Mexico. Objective: To conduct a cost-effectiveness analysis of early and new-generation drug-eluting stents from the perspective of a healthcare provider. Methods: We conducted a cost-effectiveness analysis of early and new-generation drug-eluting stents in patients with ischemic cardiomyopathy attending a Cardiology Hospital of the Mexican Social Security Institute. The health endpoint used was major acute cardiovascular events prevented. The effectiveness by stent type was obtained from the literature. A retrospective chart review study was conducted to collect cost data on cardiovascular events including seven cost categories. Average and incremental cost-effectiveness ratios were estimated. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of estimates. Results: Incremental cost-effectiveness ratios in base-case were 28,910 and US$ 35,590 for early and new-generation stents, respectively. In an optimal scenario, incremental-cost effectiveness ratio was 24,776 and US$ 25,262 for early and new stents, respectively. Probabilistic sensitivity analysis suggested that 90% of cases were cost-effective when willingness-to-pay was 58,000 and US$ 66,000 for early and new-generation stents, respectively. Conclusions: The cost-effectiveness ratios of early and new-generation stents were significantly higher than corresponding bare-metal stents.

Keywords: Cost effectiveness. Bare-metal stent. Drug-eluting stent. Social security. Angioplasty.

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