Cost-effectiveness of drug eluting stents versus bare metal stents in coronary heart disease. A systematic literature review

Objective The purpose of this study was to perform a systematic literature review to determine whether coronary disease endovascular therapy with drug eluting stents (DES) compared with bare metal stents (BMS) is cost-effective. Methods A systematic review was performed in Pubmed/Medline, Embase, CDRS, NCBI, Hinari, CRD, DARE, NHSEED, HTA, HSRPROJ, HSTAT electronic databases to identify full economic evaluation studies with health care perspective reporting the relationship between cost/absolute risk reduction and cost/QALY, without date or language limitations. Results Sixteen studies were included (21807 participants). Paclitaxel or sirolimus DES compared with BMS were evaluated in five studies (31.25%), 31.25% assessed only sirolimus eluting stents, 25% only paclitaxel eluting stents and 12.5% zotarolimus eluting stents. Health care payment perspective was explicit in 93.75% of the studies. The distribution of patient characteristics was similar in all groups and balanced in observational studies. Six of the 16 studies concluded that DES were not cost-effective in their population, but that in subgroups at greater risk of restenosis or with multiple vessel disease the therapy was cost-effective. Conclusions The studies were consistent in the reduction of target vessel revascularization frequency with DES compared to BMS without affecting mortality at 12 month follow-up. The intervention was cost-effective in studies at greater risk of restenosis or with multiple vessel disease.