Cost-Effectiveness of Drug-Eluting Stents Versus Bare Metal Stents in Clinical Practice

Schafer, Pascha; Sacrinty, Matthew; Cohen, David J.; Kutcher, Michael A.; Gandhi, Sanjay; Santos, Renato M.; Little, William C.; Applegate, Robert J.

doi:10.1161/circoutcomes.110.960187

Cited by 26 publications

(16 citation statements)

References 29 publications

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“…Interest in using DES in the endovascular management of TRAS is derived from numerous prospective studies citing their lower rates of restenosis in the treatment of coronary artery disease (CAD) (20)(21)(22)(23)(24) as well as similarities in vessel diameter of the coronary and renal arteries. However, direct extrapolation of these findings to justify the routine use of DES in the endovascular management of TRAS is confounded by factors such as large variation in vessel diameter, lesion location and etiology of stenosis.…”

Section: Introductionmentioning

confidence: 99%

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Biederman

Fischman

Titano

et al. 2015

American Journal of Transplantation

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In this study we analyze the different types of endovascular interventions (EVIs) in de novo transplant renal artery stenosis (TRAS) and its anatomical subtypes to examine any variation in recovery of allograft function, blood pressure control, EVI patency and allograft survival with respect to EVI type (DES: drug-eluting stent, BMS: bare-metal stent, PTA: percutaneous transluminal angioplasty). Forty-five patients underwent a total of 50 primary EVIs (DES: 18, BMS: 26, PTA: 6). Patients were stratified according to medical co-morbidities, graft characteristics, biopsy results, clinical presentation and TRAS anatomic subtypes (anastomotic: 26, postanastomotic: 17, bend-kink: 2). There was significant improvement in allograft function and mean arterial blood pressure (MAP) control across all interventions (pre-EVI-creatinine[CR]: 2.8 AE 1.4, post-EVI-Cr: 2.1 AE 0.7, p < 0.001; pre-EVI-MAP: 117 AE 16, post-EVI-MAP: 112 AE 17, p ¼ 0.03) with no significant difference among EVI types. There was no significant difference in allograft survival with respect to EVI type. Patency was significantly higher in EVIs performed with DES and BMS compared to PTA (p ¼ 0.001). In the postanastomotic TRAS subtype, patency rates were significantly higher in DES compared to BMS (p ¼ 0.012) in vessels of comparable reference diameter ( 5 mm).

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Section: Introductionmentioning

confidence: 99%

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Biederman

Fischman

Titano

et al. 2015

American Journal of Transplantation

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“…61 Increased competition among large medical device companies reduced further the costs of newer generation DES and it was recently shown that higher index expenditures of DES versus BMS were completely offset by lower TLR related costs. 62 BRS in Europe, Asia-Pacific and South-America are priced generally 2 to 3 times more compared to newer generation DES; however the broad clinical application of these technologies in the US market will only be achieved by showing comparable cost-effectiveness and quality-adjusted life years with current generation DES.…”

Section: The Advent Of Restoration In Interventional Cardiovascular Mmentioning

confidence: 99%

Bioresorbable scaffolds for percutaneous coronary interventions

Gogas

2014

Global Cardiology Science and Practice

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Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up).The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES).Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics were recently developed. These devices have been utilized in selected clinical applications providing preliminary evidence of safety showing comparable intermediate term clinical outcomes with current generation drug-eluting stents.

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“…70 Nevertheless, a recent analysis of stent use in routine clinical practice in the United States showed that the higher cost of drug-eluting stents, as compared with bare-metal stents, was offset by lower costs of repeat revascularization procedures over a period of 3 years. 71 Whether drug-eluting stents should be used with or without restriction remains a subject of debate, particularly in light of uncertainty regarding the optimal duration of dual antiplatelet therapy, which has a substantial effect on health care costs. 71 Moreover, a reduction in costs with the use of everolimus-eluting stents, as compared with paclitaxel-eluting stents, has recently been documented.…”

Section: Os T-effec T I V Ene Ssmentioning

confidence: 99%

“…71 Whether drug-eluting stents should be used with or without restriction remains a subject of debate, particularly in light of uncertainty regarding the optimal duration of dual antiplatelet therapy, which has a substantial effect on health care costs. 71 Moreover, a reduction in costs with the use of everolimus-eluting stents, as compared with paclitaxel-eluting stents, has recently been documented. 72 Open Issue s a nd F u t ur e Dir ec t ions…”

Section: Os T-effec T I V Ene Ssmentioning

confidence: 99%

Drug-Eluting Coronary-Artery Stents

2013

N Engl J Med

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Cost-Effectiveness of Drug-Eluting Stents Versus Bare Metal Stents in Clinical Practice

Cited by 26 publications

References 29 publications

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Bioresorbable scaffolds for percutaneous coronary interventions

Drug-Eluting Coronary-Artery Stents

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