TITLE

The cost-effectiveness of drug-eluting stents: a systematic review

AUTHOR(S)
Ligthart, Suzanne; Vlemmix, Floortje; Dendukuri, Nandini; Brophy, James M.
PUB. DATE
January 2007
SOURCE
CMAJ: Canadian Medical Association Journal;1/16/2007, Vol. 176 Issue 2, p199
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Drug-eluting stents have been seen as an attractive alternative to bare-metal stents for percutaneous coronary interventions (PCIs) because of the decreased need for revascularization. However, comparative clinical trials have shown no difference in patient outcomes, and drug-eluting stents are considerably more expensive than their bare-metal counterparts. We conducted a systematic review of all published comparative cost-effectiveness analyses to identify the factors contributing to the heterogeneity of their conclusions. Methods: We retrieved all articles published between Jan. 1, 2000, and July 31, 2006, in which the cost-effectiveness, from a third-party payer perspective, of drug-eluting stents was compared with that of bare-metal stents for PCI in unrestricted patient populations. Electronic databases, Web sites from health technology assessment groups and references of identified articles were searched. Our outcome variable was whether the study's conclusions favoured widespread use of drug-eluting stents, as assessed by 4 independent reviewers. Study characteristics such as quality, funding source, country and year of publication were extracted. Two-by-2 tables and Fisher's exact test were used to study the association between covariates and the outcome variable. A classification and regression tree (CART) model was used for multivariate analysis. Results: We identified 19 cost-effectiveness analyses. Ten were in favour of widespread use of drug-eluting stents, and 9 favoured more restrained use. Only 1 of 9 high-quality studies supported widespread use, as compared with 9 of 10 lower quality studies (p < 0.001). All of the 7 sponsored studies argued in favour of widespread use, as compared with 3 of the 12 studies without sponsorship (p = 0.003). Studies from the United States were more likely than those from other countries to endorse unlimited use (p = 0.032). A CART model with 2 covariates - study quality and sponsorship - provided the best fit (error rate 10.5%). Interpretation: Conclusions drawn by cost-effectiveness analyses of drug-eluting stents for PCI are associated with the study's quality, funding source and country of origin. Vigilance regarding these study characteristics is required when interpreting findings from cost-effectiveness analyses.
ACCESSION #
23761077

 

Related Articles

  • DIRECT STENT DEPLOYMENT USING 5 FRENCH GUIDING CATHETERS VIA THE RADIAL ARTERY IS BOTH FEASIBLE AND EFFECTIVE.  // Heart;May2001 Supplement 1, Vol. 85, pP25 

    This article determines that direct stent deployment using 5 French guiding catheters via the radial artery is both feasible and effective. The progressive miniaturisation of equipment for percutaneous intervention has lead to significant advances in the technique over the past two decades. Full...

  • Using meta-regression analyses in addition to conventional systematic review methods to examine the variation in cost-effectiveness results - a case study. Burgers, Laura T.; van de Wetering, Fleur T.; Severens, Johan L.; Redekop, W. Ken // BMC Health Services Research;1/20/2016, Vol. 16, p1 

    Background: Systematic reviews of cost-effectiveness analyses summarize results and describe study characteristics. Variability in the study results is often explained qualitatively or based on sensitivity analyses of individual studies. However, variability due to input parameters...

  • Drug-Eluting Stents in Acute Myocardial Infarction: Is Science Catching Up With Practice? Cohen, Mauricio G.; Ohman, E. Magnus // JAMA: Journal of the American Medical Association;5/4/2005, Vol. 293 Issue 17, p2154 

    Comments on the use of drug-eluting stents in the treatment of myocardial infarction. Impact of drug-eluting stents on the success of interventional cardiology; History of the use of drug-eluting stents in clinical practice in the U.S.; Potential efficacy of drug-eluting stents in the treatment...

  • ENDOVASCULAR TECHNIQUES IN LIMB SALVAGE: STENTS. El-Sayed, Hosam F. // Methodist DeBakey Cardiovascular Journal;Apr/June2013, Vol. 9 Issue 2, p79 

    In patients with critical limb ischemia, the first-line approach for limb salvage has shifted over the past decade from bypass surgery to endovascular intervention. Stenting for the treatment of lower-extremity arterial occlusive disease is an important tool and continues to evolve, with new...

  • Who is Asian? A category that remains contested in population and health research. Aspinall, Peter J. // Journal of Public Health Medicine;Jun2003, Vol. 25 Issue 2, p91 

    Continuing inconsistent use of the term ‘Asian’ and its appearance for the first time in the 2001 Census justifies an examination of its utility in population and health research. Given the potential for ‘Asian’ to describe either persons with origins in the Indian...

  • The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. Black, Ashly D.; Car, Josip; Pagliari, Claudia; Anandan, Chantelle; Cresswell, Kathrin; Bokun, Tomislav; McKinstry, Brian; Procter, Rob; Majeed, Azeem; Sheikh, Aziz // PLoS Medicine;Jan2011, Vol. 8 Issue 1, p1 

    Background: There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact...

  • ReoPro gives an edge to stent patients. Cerrato, Paul L. // RN;Dec98, Vol. 61 Issue 12, p84 

    Reports on a multi-hospital trial which found that abciximab (ReoPro) greatly improves the safety of coronary stenting procedures. Reduction of the number of major bleeding complications.

  • Controversy over cost effectiveness of drug-eluting stents.  // PharmacoEconomics & Outcomes News;2/25/2006, Issue 497, p5 

    Discusses research on the cost effectiveness of drug eluting coronary artery stenting in patients in Great Britain. Reference to a study by A. Bagust et al, published in the January 2006 issue of the "Heart"; Analysis of data from patients who received stent placements; Risk of repeat...

  • Giving enteral medications. Phillips, Nicole Margaret // Australian Nursing Journal;Oct2007, Vol. 15 Issue 4, p41 

    The article focuses on a systematic review of the best available evidence on providing medication to a patient through an enteral tube of interest to nurses in Australia. The review is said to consider issues including the use of liquid and solid forms of medication, their preparation and...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics