From the ESC Congress 2005: Drug-eluting stent is cost-effective only in high-risk subsets

In a "real-world" setting, drug-eluting stents are clinically superior to bare metal stents, but their use is currently cost-effective only in high-risk subsets of patients, according to results from BASKET (Basel Stent Kosten Effektivitäts Trial).

The argument that the use of drug-eluting stents in all patients would result in lower total healthcare costs through avoidance of repeat revascularizations was not borne out in BASKET, said lead investigator Matthias E. Pfisterer, MD, University Hospital Basel, Switzerland.

In BASKET, 826 consecutive patients with 1,281 de novo lesions were randomized to a drug-eluting stent (Cypher or Taxus) or a cobalt chromium bare metal stent (Vision).

Total costs at 6 months were higher in patients who received a drug-eluting stent compared with the bare metal stent (13,619 vs 12,450; P<.001). Converted to dollars, the incremental cost to prevent 1 event with a drug-eluting stent was $23,860, which is substantially above the accepted $10,000 benchmark for cost effectiveness, said Dr Pfisterer.

The groups in which the cost-effectiveness of drug-eluting stents was <$10,000 per event avoided were patients aged >65 years or patients with vessels ≤2.5 mm in diameter, lesions longer than 20 mm, more than 1 affected vessel segment, or more than 2 affected vessels.

"Drug-eluting stents may be restricted to special high-risk groups where they are more cost-effective," Dr Pfisterer said. High-risk patients are those older than 65 years with 3-vessel disease who require multiple and/or long stents in predominantly small vessels, he said. A reduction in the price of drug-eluting stents would expand the population in which they would be cost-effective, he added.