Despite higher initial costs of drug-eluting stents (DES), the lower follow-up costs during the first year resulted in relatively small cumulative cost differences between DES and bare-metal stent (BMS) recipients, according to study published in the June issue of the American Heart Journal.
The authors noted that while clinical trials predict the higher initial costs of DES compared to BMS would be partially offset by decreased costs during the first year after PCI, the costs of DES in non-experimental, or real-life, settings are not well understood.
Peter W. Groeneveld, MD, from the department of medicine at the University of Pennsylvania School of Medicine in Philadelphia and colleagues used a random, nationwide sample of Medicare beneficiaries who had received either DES from April through December 2003 or BMS from July 2002 through December 2003.
The researchers separately matched propensity score methods of DES recipients (4,375 patients) to historical and contemporary BMS controls. They estimated costs for each patient based on all physician and institutional claims beginning with the PCI hospitalization through the subsequent year, with institutional charges converted to costs via cost-center specific cost-to-charge ratios, as reported to Medicare by each institution.
The investigators found that DES patients had higher 30-day costs compared to both historical controls (mean difference $2,131) and contemporary controls ($1,882). At one year, Groenveld and colleagues found that DES-BMS mean cost differences had diminished substantially ($647 compared to historical controls; -$84 compared to contemporary controls) and were no longer statistically significant.
The authors wrote that the differences are comparable to those modeled in economic studies predicting acceptable cost-effectiveness for DES.