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BMJ. 2007 November 10; 335(7627): 962.
PMCID: PMC2072035
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Drug eluting stents not cost effective for low risk patients

In general, drug eluting stents aren't good value for moneymoney.. They are more expensive than bare metal stents, and European researchers recently estimated that if every patient had one, each cardiac event averted over 18 months would cost an extra €64 732 (£45 000; $94 000). Each additional quality adjusted life year would cost €40 467. Both figures were above what the researchers considered a reasonable cut-off point for cost effectiveness—€10 000 for each event and €40 000 for each quality adjusted life year.

figure scut1011.f1

Drug eluting stents look more cost effective when reserved for high risk patients, however. In this analysis, which was based on a randomised trial, drug eluting stents prevented cardiac events and improved quality of life only in patients with small vessel disease or those who needed stenting of bypass grafts. The chance of drug eluting stents being cost effective in this subgroup was around 90%. For low risk patients with disease in a large coronary artery, the chance of drug eluting stents being cost effective was close to zero.

The problem seems to be that for most patients the extra benefits of drug eluting stents simply aren't big enough to offset their initial cost. Prices are falling, but they're falling faster for metal stents than for drug eluting stents. So the situation is unlikely to change soon, say the researchers.

References

  • Lancet 2007;370:1552-9

Articles from The BMJ are provided here courtesy of BMJ Publishing Group