PCV108 - Cost-Effectiveness of Drug-Eluting Stents Versus Bare Metal Stents in Egyptian Diabetic Patients

Abstract

Cost-effectiveness of Drug eluting stents (DES) versus bare metal stents (BMS) in Egyptian diabetic patients with chronic coronary artery disease from a patient perspective was evaluated over a time horizon of 3 years. A cohort Markov process model with five health states: stent, coronary artery bypass surgery (CABG), non-fatal myocardial infarction (MI), percutaneous coronary intervention (PCI) and death was derived from published data. The transition probabilities from the index procedure to death, MI, PCI, and CABG were derived from an updated, previously published meta-analysis of RCTs comparing DES with BMS in patients with coronary artery disease. Relative risk reduction, restenosis risks, mortality rates, utilities were derived using published sources. Direct Medical costs were obtained from 4 top-rated cardiology hospitals in Egypt. All costs and effects were discounted at 3.5% annually. All costs were reported in Egyptian pounds of the financial year 2013. Deterministic sensitivity analysis was conducted. In the overall population, total costs for DES and BMS were 20,664 EGP and 11,957 EGP respectively. Total QALYs for DES and BMS were 2.26 and 2.05 respectively. The incremental cost-effectiveness ratio (ICER) for DES versus BMS was 41,616 EGP/QALY. DES is cost effective because it is less than 3 times GDP/capita in Egypt (57,566 EGP). Results between DES and BMS were most sensitive to the Mortality rate of both DES and BMS. World Health Organization recommends that interventions that cost more than 3 times GDP/capita for one Disability Adjusted Life Year (DALY) avoided should not be reimbursed. Despite DALY is different from QALY but we can assume that they are similar to be able to put a value on the outcome. DES represents a good value for money compared to BMS in Egyptian diabetic patients with chronic coronary artery disease.