Authors: Canoui-Poitrine, Florence; Jeanblanc, Grégoire¹; Alberti, Corinne; Armoogum, Priscilla²; Cebrian, Ana³; Carrié, Didier⁴; Henry, Patrick⁵; Teiger, Emmanuel¹; Slama, Michel⁶; Spaulding, Christian; Durand-Zaleski, Isabelle¹

Source: Applied Health Economics and Health Policy, Volume 7, Number 1, 1 March 2009 , pp. 19-29(11)

Publisher: Adis International

Abstract:

Background Drug-eluting stents have been shown to reduce the rate of repeat revascularization after percutaneous coronary intervention for acute myocardial infarction (AMI) as compared with bare metal stents (BMS). A few studies have reported the cost effectiveness of sirolimus-eluting stents (SES) in several countries, but none in the particular setting of AMI in France.

Objectives To assess the cost effectiveness of SES compared with BMS in a pre-specified subgroup of French patients with AMI in the randomized, multicentre TYPHOON trial.

Methods A prospective economic evaluation was conducted for the 337 patients in the TYPHOON trial who were enrolled in the French centres. In the TYPHOON trial, patients with AMI with ST-segment elevation less than 12 hours after the onset of chest pain were randomized to undergo percutaneous coronary intervention with either SES or BMS. Data on clinical outcomes and resource use were collected prospectively over a 1-year follow-up period (from October 2003 to October 2005). Unit costs were applied to the resource utilization data. The main outcome measure was the incremental cost-effectiveness ratio (ICER) for additional cost per target-vessel revascularization (TVR) avoided. The perspective of the study was the French healthcare system and costs were expressed in 2007 values.

Results SES significantly reduced the rate of TVR (6.6% vs 22.2% with BMS, p < 0.0001). There was no difference in the rate of death, recurrent myocardial infarction or stent thrombosis after 1 year of follow-up between the SES and BMS groups. Mean index admission costs, including the angioplasty procedure, were increased by €1282 per patient in the SES group, mostly driven by the price of the SES. Mean follow-up costs were €140 per patient lower in the SES group. Mean aggregate 1-year costs showed a €1142 per-patient increase in the SES group compared with the BMS group. The ICER was €7321 per TVR avoided.

Conclusion In this pre-specified subgroup analysis of the TYPHOON trial, the use of SES in patients with AMI with ST-segment elevation less than 12 hours after the onset of chest pain reduced the rate of TVR compared with BMS. However, SES had a debatable ICER for the payer if it was based only on the specific benefit of TVR avoided.

Document Type: Research article

Affiliations: 1: 1 Assistance Publique - Hopitaux de Paris (AP-HP), Henri Mondor Hospital, EA 4393, Paris 12 Medical School, Créteil, France 2: 3 AP-HP, Unit of Clinical Epidemiology, Robert Debre Hospital, Paris, France 3: 5 Cordis (Johnson & Johnson), Waterloo, Belgium 4: 6 Rangueil Hospital, Toulouse, France 5: 7 AP-HP, Lariboisiere-Saint Louis Hospital, Paris 7 Medical School, Denis Diderot University, Paris, France 6: 8 AP-HP, Antoine Beclere Hospital, Paris 11 Medical School, Paris Sud University, Clamart, France

Publication date: 2009-03-01

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