Cost-Effectiveness of a Novel Self-Apposing Stent in ST-Segment Elevation Myocardial Infarction (STEMI) in France

L. Annemans, J. Silvain, G. Montalescot
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Abstract

The objective was to calculate the cost-effectiveness profile of STENTYS compared to conventional bare and drug-eluting stents (DES). Stents are widely used in the treatment of patients with ST-segment elevation myocardial infarction (STEMI). However, several reports point to the prevailing risk of coronary events such as recurrent myocardial infarction, some of which are related to in-stent thrombosis, possibly explained by poorly apposed stents. 1-year results of the self-apposing stent, STENTYS, are promising regarding the incidence of fatal and non-fatal cardiovascular (CV) events. A model was developed to simulate costs and quality-adjusted life years (QALYs) over 1-5 years. In the first 12 months, a decision tree framework was used to define different CV outcomes for STEMI patients receiving a stent. After 12 months, outcomes were categorised in a Markov stage of the model as myocardial infarction (MI), other CV events, revascularisation, and death. Cost of comparative treatments and follow-up in relation to CV events were calculated from the French health insurance perspective. The results indicated, in the base case, over a time horizon of 5 years, that STENTYS bare metal stent (BMS) is dominant (less costly and more QALYs) against conventional DES. The STENTYS DES is dominant compared with conventional DES and very cost-effective versus BMS. The results were robust for different variations in the input variables. This first analysis of the cost-effectiveness of STENTYS showed that it is dominant or very costeffective as compared to conventional stents. Further comparative research and longer follow-up data are needed to expand on these results.
法国st段抬高型心肌梗死(STEMI)的新型自体支架的成本-效果
目的是计算STENTYS与传统裸支架和药物洗脱支架(DES)相比的成本效益。支架广泛应用于st段抬高型心肌梗死(STEMI)的治疗。然而,一些报告指出了冠状动脉事件的普遍风险,如复发性心肌梗死,其中一些与支架内血栓形成有关,可能是由于支架放置不良所致。自置支架STENTYS的1年研究结果显示,在致死性和非致死性心血管(CV)事件的发生率方面,STENTYS是有希望的。开发了一个模型来模拟1-5年的成本和质量调整寿命年(QALYs)。在前12个月,决策树框架用于定义STEMI患者接受支架的不同CV结果。12个月后,在模型的马尔可夫阶段将结果分类为心肌梗死(MI)、其他心血管事件、血运重建和死亡。从法国健康保险的角度计算与心血管事件相关的比较治疗和随访费用。结果表明,在基础病例中,在5年的时间范围内,STENTYS裸金属支架(BMS)与传统DES相比占主导地位(成本更低,质量更高)。与传统DES相比,STENTYS裸金属支架(BMS)占主导地位,与BMS相比具有非常高的成本效益。结果对输入变量的不同变化具有鲁棒性。对STENTYS成本效益的首次分析表明,与传统支架相比,STENTYS具有优势或非常具有成本效益。需要进一步的比较研究和更长的随访数据来扩展这些结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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