European Heart Journal Advance Access originally published online on November 17, 2006
European Heart Journal 2006 27(24):2996-3003; doi:10.1093/eurheartj/ehl357
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Cost-effectiveness of the unrestricted use of sirolimus-eluting stents vs. bare metal stents at 1 and 2-year follow-up: results from the RESEARCH Registry
Thoraxcenter, Erasmus Medical Center, Ba-583, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Received 12 January 2006; revised 6 October 2006; accepted 12 October 2006; online publish-ahead-of-print 17 November 2006.
* Corresponding author. Tel: +31 10 463 5260; fax: +31 10 436 9154. E-mail address: p.w.j.c.serruys{at}erasmusmc.nl
Aims To assess the cost-effectiveness of sirolimus-eluting stents (SESs) compared with bare metal stents (BMSs) as the default strategy in unselected patients treated in the Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) Registry at 1 and 2-years following the procedure.
Methods and results A total of 508 consecutive patients with de novo lesions exclusively treated with SES were compared with 450 patients treated with BMS from the immediate preceding period. Resource use and costs of the index procedure, and clinical outcomes were prospectively recorded over a 2-year follow-up period. Follow-up costs were measured as unit costs per patient based on the incidence of clinically driven target vessel revascularization (TVR), to obtain cumulative costs at 1 and 2-years. Cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER) per TVR avoided.
The use of SES cost 
3036 more per patient at the index procedure, driven by the price of SES. Follow-up costs after 1-year were 1,089 less with SES when compared with BMS, due to less TVR, resulting in a net excess cost of 1968 per patient in the SES group, and reduced by a further 100 per patient in the second year. The incidence of death or myocardial infarction between groups was similar at 1 and 2 years. Rates of TVR in the SES and BMS groups were 3.7% vs. 10.4%, P<0.01 at 1 year, respectively; and 6.4% vs. 14.7%, P<0.001 at 2 years. The ICER per TVR avoided was 29 373 at 1 year, and 22 267 at 2 years.
Conclusion The use of SES, while significantly beneficial in reducing the need for repeat revascularization, was more expensive and not cost-effective in the RESEARCH registry at either 1 or 2-years when compared with BMS. On the basis of these results, in an unselected population with 1 year of follow-up, the unit price of SES would have to be 1023 in order to be cost-neutral.
Key Words: Cost-effectiveness • Drug-eluting stents • Sirolimus • Real-world • Registry
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