This research was supported by an unrestricted grant from the Institute for Health Technology Studies (InHealth). Dr. Groeneveld was additionally supported by a Research Career Development Award from the Department of Veterans Affairs' Health Services Research and Development Service.
The Costs and Quality-of-Life Outcomes of Drug-Eluting Coronary Stents: A Systematic Review
Article first published online: 30 JAN 2007
Journal of Interventional Cardiology
Volume 20, Issue 1, pages 1–9, February 2007
How to Cite
GROENEVELD, P. W., SUH, J. J. and MATTA, M. A. (2007), The Costs and Quality-of-Life Outcomes of Drug-Eluting Coronary Stents: A Systematic Review. Journal of Interventional Cardiology, 20: 1–9. doi: 10.1111/j.1540-8183.2007.00214.x
- Issue published online: 30 JAN 2007
- Article first published online: 30 JAN 2007
Objectives: While the efficacy of drug-eluting coronary stents (DES) has been demonstrated by several clinical trials, the impact of DES on health-care costs and recipient quality of life (QOL) is controversial. We performed a systematic review of the published literature on DES costs and the QOL effects of restenosis and target vessel revascularization (TVR).
Methods: Among 536 potential articles initially identified by a broad search, 12 publications ultimately met inclusion criteria. Data were independently abstracted, evaluated for quality and relevance, and summarized by two reviewers. Excessive heterogeneity among these studies prevented formal meta-analysis, thus a narrative synthesis of the literature was performed.
Results: In four economic studies, DES recipients had $1,600–$3,200 higher up-front costs than recipients of bare metal stents, but the differences in total costs after 1 year were less pronounced ($200–$1,200), and estimates of the average cost of an avoided revascularization ranged widely ($1,800–$36,900). All eight QOL studies indicated that restenosis was associated with lower QOL, but only two studies quantified this in terms of quality-adjusted life years (QALYs), with estimates ranging from 0.06 to 0.08. An additional study estimated that the median willingness to pay to prevent restenosis was $2,400–$3,600.
Conclusions: There is a lack of convergence in the literature on the cost of DES in avoiding TVR. There is more agreement that the average QALY benefit of an avoided revascularization is 0.04–0.08. This implies that use of DES in patients where the average cost per avoided revascularization exceeds $8,000 may be less likely to be cost-effective.