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

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.