Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Use of Drug-eluting Stents Versus Bare-metal Stents in Korea: A Cost-minimization Analysis Using Population Data

  • Suh, Hae Sun (National Evidence-based Healthcare Collaborating Agency) ;
  • Song, Hyun Jin (National Evidence-based Healthcare Collaborating Agency) ;
  • Jang, Eun Jin (National Evidence-based Healthcare Collaborating Agency) ;
  • Kim, Jung-Sun (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Choi, Donghoon (National Evidence-based Healthcare Collaborating Agency) ;
  • Lee, Sang Moo (National Evidence-based Healthcare Collaborating Agency)
  • Received : 2013.05.16
  • Accepted : 2013.07.11
  • Published : 2013.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: The goal of this study was to perform an economic analysis of a primary stenting with drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) admitted through an emergency room (ER) visit in Korea using population-based data. Methods: We employed a cost-minimization method using a decision analytic model with a two-year time period. Model probabilities and costs were obtained from a published systematic review and population-based data from which a retrospective database analysis of the national reimbursement database of Health Insurance Review and Assessment covering 2006 through 2010 was performed. Uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analyses. Results: Among 513 979 cases with AMI during 2007 and 2008, 24 742 cases underwent stenting procedures and 20 320 patients admitted through an ER visit with primary stenting were identified in the base model. The transition probabilities of DES-to-DES, DES-to-BMS, DES-to-coronary artery bypass graft, and DES-to-balloon were 59.7%, 0.6%, 4.3%, and 35.3%, respectively, among these patients. The average two-year costs of DES and BMS in 2011 Korean won were 11 065 528 won/person and 9 647 647 won/person, respectively. DES resulted in higher costs than BMS by 1 417 882 won/person. The model was highly sensitive to the probability and costs of having no revascularization. Conclusions: Primary stenting with BMS for AMI with an ER visit was shown to be a cost-saving procedure compared with DES in Korea. Caution is needed when applying this finding to patients with a higher level of severity in health status.

Keywords

References

  1. Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009;120(22):2271-2306. https://doi.org/10.1161/CIRCULATIONAHA.109.192663
  2. Nordmann AJ, Hengstler P, Leimenstoll BM, Harr T, Young J, Bucher HC. Clinical outcomes of stents versus balloon angioplasty in non-acute coronary artery disease. A meta-analysis of randomized controlled trials. Eur Heart J 2004;25(1):69-80. https://doi.org/10.1016/j.ehj.2003.10.001
  3. Hill RA, Boland A, Dickson R, Dündar Y, Haycox A, McLeod C, et al. Drug-eluting stents: a systematic review and economic evaluation. Health Technol Assess 2007;11(46):iii, xi-221.
  4. Suh HS, Song HJ, Choi JE, Jang EJ, Son HJ, Lee SM, et al. Drugeluting stents versus bare-metal stents in acute myocardial infarction: a systematic review and meta-analysis. Int J Technol Assess Health Care 2011;27(1):11-22. https://doi.org/10.1017/S0266462310001340
  5. Park KW, Kang SH, Chung WY, Lee HY, Park JS, Kang HJ, et al. 'Real world' comparison of drug-eluting stents vs bare metal stents in the treatment of unselected patients with acute STsegment elevation myocardial infarction. Circ J 2010;74(6):1111-1120. https://doi.org/10.1253/circj.CJ-09-0936
  6. National Health Insurance Corporation. Examination of healthcare expenditure for patients with health insurance in 2010. Seoul: National Health Insurance Corporation; 2011, p.172 (Korean).
  7. Korea Centers for Disease Control and Prevention. The Korea National Health and Nutrition Examination Survey (KNHANES III). Seoul: Korea Centers for Disease Control and Prevention; 2005, p. 174, 177 (Korean).
  8. Korean Statistical Information Service. Consumer price index in transportation; 2011 [cited 2012 Nov 15]. Available from: http://kosis.kr (Korean).
  9. Lord SJ, Howard K, Allen F, Marinovich L, Burgess DC, King R, et al. A systematic review and economic analysis of drug-eluting coronary stents available in Australia. Med J Aust 2005;183(9):464-471.
  10. Neyt M, De Laet C, De Ridder A, Van Brabandt H. Cost effectiveness of drug-eluting stents in Belgian practice: healthcare payer perspective. Pharmacoeconomics 2009;27(4):313-327. https://doi.org/10.2165/00019053-200927040-00004
  11. Ong AT, Daemen J, van Hout BA, Lemos PA, Bosch JL, van Domburg RT, et al. 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. Eur Heart J 2006;27(24):2996-3003. https://doi.org/10.1093/eurheartj/ehl357
  12. Cho Y, Yang HM, Park KW, Chung WY, Choi DJ, Seo WW, et al. Paclitaxel- versus sirolimus-eluting stents for treatment of STsegment elevation myocardial infarction: with analyses for diabetic and nondiabetic subpopulation. JACC Cardiovasc Interv 2010;3(5):498-506. https://doi.org/10.1016/j.jcin.2010.02.011
  13. Kim KH, Koo BK, Min HS, Park SK, Kim CH, Park KW, et al. Comparison of drug-eluting versus bare-metal stent implantation in ST-elevation myocardial infarction patients with renal insufficiency: results from the national registry in Korea. Int J Cardiol 2012;154(1):71-77. https://doi.org/10.1016/j.ijcard.2010.09.012
  14. Park K, Park KW, Rha SW, Bae JH, Hur SH, Park JS, et al. Comparison of 5-year clinical outcomes between sirolimus-versus paclitaxel-eluting stent: Korean multicenter network analysis of 9000-patient cohort. Circ Cardiovasc Interv 2012;5(2):174-184. https://doi.org/10.1161/CIRCINTERVENTIONS.111.964650
  15. Park KW, Cho YS, Chung JW, Yeon TJ, Chae IH, Choi DJ, et al. One year clinical and six month angiographic results of drug eluting stents for ST elevation acute myocardial infarction: 'real world' comparison between sirolimus- and paclitaxeleluting stents. Int J Cardiol 2009;131(3):350-355. https://doi.org/10.1016/j.ijcard.2007.10.025
  16. Park KW, Lim WH, Kim JH, Kang SH, Seo JW, Song YB, et al. Comparison between zotarolimus-eluting stents and first generation drug-eluting stents in the treatment of patients with acute ST-segment elevation myocardial infarction. Int J Cardiol 2013;166(1):118-125. https://doi.org/10.1016/j.ijcard.2011.10.012
  17. Sim DS, Jeong MH, Ahn Y, Kim YJ, Chae SC, Hong TJ, et al. Effectiveness of drug-eluting stents versus bare-metal stents in large coronary arteries in patients with acute myocardial infarction. J Korean Med Sci 2011;26(4):521-527. https://doi.org/10.3346/jkms.2011.26.4.521
  18. Park BJ, Sung JH, Park KD, Seo SW, Kim SW. Strategies to improve the validity of diagnostic codes of National Health Insurance claims data. Seoul: Health Insurance Review and Assessment Services; 2002, p. vi, 118-119 (Korean).
  19. Brar SS, Leon MB, Stone GW, Mehran R, Moses JW, Brar SK, et al. Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis. J Am Coll Cardiol 2009;53(18):1677-1689. https://doi.org/10.1016/j.jacc.2009.03.013
  20. Di Lorenzo E, Sauro R, Varricchio A, Carbone G, Cortese G, Capasso M, et al. Long-Term outcome of drug-eluting stents compared with bare metal stents in ST-segment elevation myocardial infarction: results of the paclitaxel- or sirolimuseluting stent versus bare metal stent in Primary Angioplasty (PASEO) Randomized Trial. Circulation 2009;120(11):964-972. https://doi.org/10.1161/CIRCULATIONAHA.108.830372
  21. Genereux P, Mehran R. Are drug-eluting stents safe in the long term? CMAJ 2009;180(2):154-155. https://doi.org/10.1503/cmaj.081907

Cited by

  1. A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities vol.26, pp.10, 2013, https://doi.org/10.1177/1357633x19853139