Antiproliferative Drug-Eluting Stents: Systematic Review of the Benefits and Estimate of Economic Impact

Oliva, Glòria; Espallargues, Mireia; Pons, Juan Manuel

doi:10.1016/s1885-5857(06)60285-5

Cited by 10 publications

(13 citation statements)

References 37 publications

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“…QoL among surviving patients in the stenting group was 0.69 (±0.20) at base line, and 0.84 (±0.16), 0.86 (±0. 16), and 0.86 (±0.16) respectively 1, 6 and 12 months after the intervention [47].…”

Section: Utilitiesmentioning

confidence: 97%

“…The remaining 67 studies were retrieved and 17 studies fulfilled the inclusion criteria. A few studies were not included because a more recent paper based on the same model with more up-to-date data was available [15], because only a cost and threshold analysis was published [16,17], because the analysis was performed from a hospital perspective estimating budget impact or profit/loss [18,19], or because both a full report and a paper with the same content were published [20,21]. In the latter case, input and results were retrieved from the full reports [22,23].…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

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Cost-effectiveness analyses of drug eluting stents versus bare metal stents: A systematic review of the literature

et al. 2009

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Section: Utilitiesmentioning

confidence: 97%

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Cost-effectiveness analyses of drug eluting stents versus bare metal stents: A systematic review of the literature

et al. 2009

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“…Several studies examined the decline in DES price required for DES to be cost neutral (the break-even price). 44,45 Several studies examined the impact of DES penetration on hospital budgets, 46,47 and other studies examined the impact of DES on global healthcare budgets. 48 -51 The conclusions from these studies can be summarized as follows.…”

Section: Other Des Cost Studiesmentioning

confidence: 99%

Are Drug-Eluting Stents Cost-Effective?

Ryan

Cohen

2006

Circulation

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Since their commercial introduction in 2003, drugeluting stents (DES) have rapidly altered the management of coronary artery disease. Before their development, the percutaneous management of coronary artery disease was performed predominantly by implantation of bare metal stents (BMS) made of either surgical stainless steel or metal alloys. Although such stents represented a considerable advance over balloon angioplasty alone, they remained limited by restenosis resulting from neointimal proliferation. As a result, Ϸ15% to 20% of patients treated with BMS required Ն1 repeat revascularization procedure within the 6 to 12 months after stent implantation. 1 Despite numerous attempts at systemic pharmacotherapy, device modification, and even use of ionizing radiation, the rate of restenosis after BMS implantation remained largely unaffected. Response by Eisenberg p 1744Over the past 5 years, effective DES have become the first device to substantially reduce the incidence of restenosis after stent implantation. By delivering high concentrations of either antiproliferative or immunomodulatory compounds directly to the site of arterial injury and by controlling this delivery through polymer-based drug release, both sirolimus-and paclitaxel-eluting stents have safely and effectively inhibited the proliferative process that results in in-stent restenosis. In pivotal clinical trials, both sirolimus-and paclitaxel-eluting stents have reduced rates of angiographic restenosis by 70% to 90% compared with conventional BMS designs, with parallel reductions in the need for clinically driven target vessel revascularization (TVR). 2-4 As a result, in April 2003, DES were approved for use in clinical practice in the United States. Within 9 months of their introduction, DES made up 35% of all stent implantations in the United States, 5 and their use has increased rapidly since that time. At our own institution, DES comprised Ͼ85% of all stents implanted during the past year, and national estimates are that Ͼ90% of all percutaneous coronary intervention (PCI) procedures currently performed in the United States involve Ն1 DES.Given current procedural volumes (Ͼ1 million PCI procedures were performed in the United States in 2004) 6 and costs (DES are generally 3 to 4 times more expensive than BMS), the rapid growth of this technology has raised important concerns about cost from both a hospital and a societal perspective. 7,8 Because annual increases in US healthcare expenditures consistently outpace inflation, 9 there is increasing interest in formally evaluating the economic impact of new technologies both before and immediately after their introduction. The aim of the present report is to summarize the economic consequences of current DES use and to explore the possible future impact of DES on US healthcare expenses.

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“…Coronary stenting currently represents the default strategy during percutaneous coronary interventions (PCI) (1,2). In-stent restenosis (ISR), however, remains the major limitation of this therapy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

mentioning

confidence: 99%

Long-Term Results (Three to Five Years) of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Stenting (RIBS) Randomized Study

Alfonso

Augé

Zueco

et al. 2005

Journal of the American College of Cardiology

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Antiproliferative Drug-Eluting Stents: Systematic Review of the Benefits and Estimate of Economic Impact

Cited by 10 publications

References 37 publications

Cost-effectiveness analyses of drug eluting stents versus bare metal stents: A systematic review of the literature

Cost-effectiveness analyses of drug eluting stents versus bare metal stents: A systematic review of the literature

Are Drug-Eluting Stents Cost-Effective?

Long-Term Results (Three to Five Years) of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Stenting (RIBS) Randomized Study

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