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The costs and quality-of-life outcomes of drug-eluting coronary stents: a systematic review.

Abstract：

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 dollars-3,200 dollars higher up-front costs than recipients of bare metal stents, but the differences in total costs after 1 year were less pronounced (200 dollars-1,200 dollars), and estimates of the average cost of an avoided revascularization ranged widely (1,800 dollars-36,900 dollars). 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 dollars-3,600 dollars. 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 dollars may be less likely to be cost-effective.

journal_name

J Interv Cardiol

journal_title

Journal of interventional cardiology

authors

Groeneveld PW,Suh JJ,Matta MA

doi

10.1111/j.1540-8183.2007.00214.x

subject

Has Abstract

pub_date

2007-02-01 00:00:00

pages

1-9

issue

1

eissn

0896-4327

issn

1540-8183

pii

JOIC214

journal_volume

20

pub_type

杂志文章,评审

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