PMID- 15875500
OWN - NLM
STAT- MEDLINE
DCOM- 20060119
LR  - 20071115
IS  - 1129-4728 (Print)
IS  - 1129-4728 (Linking)
VI  - 6
IP  - 3
DP  - 2005 Mar
TI  - [Drug-eluting stents: from the results of clinical studies to economic simulation 
      models in the Italian reality].
PG  - 145-56
AB  - Several studies with drug-eluting stents (DES) have demonstrated dramatic 
      reductions in restenosis rates compared with bare metal stents (BMS). Although 
      the clinical benefits of DES are increasingly evident, important concerns about 
      their costs have been raised. Most data regarding the impact of restenosis on 
      long-term costs after percutaneous coronary intervention (PCI) are derived from 
      clinical trials. These studies demonstrate that there is no single cost or 
      economic burden of restenosis; these values vary substantially according to the 
      specific patient population under investigation and to the healthcare system 
      reality where they are applied. In the present study we propose an economic 
      interactive decision model which was applied to the Italian healthcare system, 
      considering the different reimbursement rates of the Italian regions for DES and 
      for both PCI and coronary artery bypass surgical interventions (CABG). The aim of 
      this model was to simulate the impact of DES introduction after potential 
      complete reimbursement by the national healthcare system, hypothesizing the usage 
      of 1.4 stent per patient in case of single vessel disease and 2.4 stents in case 
      of multivessel disease, and utilizing the TAXUS IV rate of revascularization for 
      reintervention costs calculation and the ARTS-I study for CABG costs. For a low 
      risk patients' population, the mean cost of a procedure with DES was 6% greater 
      than utilizing BMS (xi 8125 for DES vs xi 7651 for BMS). However, this percentage 
      was reduced in case of diabetic patients (+4%), long lesions (+2%) and was 
      favourable for small vessels (-3%). In addition, in case of multivessel disease 
      with conversion from CABG to DES, the 12 months cost per patients was reduced of 
      around 30% (xi 10 170 for PCI vs xi 14 584 for CABG). This model suggests that 
      national healthcare system may save 2.1% of the total costs (xi 18.60 millions) 
      if 60% of revascularization procedures converts to total DES utilization and 15% 
      from CABG to PCI with DES.
FAU - Sangiorgi, Giuseppe
AU  - Sangiorgi G
AD  - Cardiologia Interventistica, EMO Centro Cuore Columbus e Ospedale San Raffaele, 
      Milano.
FAU - Rodamni, Peppa
AU  - Rodamni P
FAU - Airoldi, Flavio
AU  - Airoldi F
FAU - Colombo, Antonio
AU  - Colombo A
LA  - ita
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Stent a rilascio di farmaco: dai risultati degli studi clinici ai modelli di 
      impatto economico-sanitario nella realta italiana.
PL  - Italy
TA  - Ital Heart J Suppl
JT  - Italian heart journal. Supplement : official journal of the Italian Federation of 
      Cardiology
JID - 101223651
SB  - IM
MH  - Clinical Trials as Topic
MH  - Drug Delivery Systems
MH  - Female
MH  - Humans
MH  - Italy
MH  - Male
MH  - Models, Economic
MH  - *Stents
RF  - 52
EDAT- 2005/05/07 09:00
MHDA- 2006/01/20 09:00
CRDT- 2005/05/07 09:00
PHST- 2005/05/07 09:00 [pubmed]
PHST- 2006/01/20 09:00 [medline]
PHST- 2005/05/07 09:00 [entrez]
PST - ppublish
SO  - Ital Heart J Suppl. 2005 Mar;6(3):145-56.