INTERVENTIONAL CARDIOLOGY AND SURGERY

One year cost effectiveness of sirolimus eluting stents compared with bare metal stents in the treatment of single native de novo coronary lesions: an analysis from the RAVEL trial

B A van Hout¹, P W Serruys², P A Lemos³, M J B M van den Brand², G-A van Es⁴, W K Lindeboom⁴, M-C Morice⁵

¹ Universitair Medisch Centrum, Julius Centrum, Utrecht, the Netherlands
² Erasmus Medical Centre, Thoraxcentre, Rotterdam, the Netherlands
³ Heart Institute (InCor)-University of Sao Paulo Medical School, Sao Paulo, Brazil
⁴ Cardialysis BV, Rotterdam, the Netherlands
⁵ Institut Cardiovasculaire Paris Sud, Massy, France

Correspondence to:
Correspondence to:
Professor Patrick W Serruys
Thoraxcentre, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, Netherlands; p.w.j.c.serruys{at}erasmusmc.nl

Objective: To assess the balance between costs and effects of the sirolimus eluting stent in the treatment of single native de novo coronary lesions in the RAVEL (randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions) study.

Design: Multicentre, double blind, randomised trial

Setting: Percutaneous coronary intervention for single de novo coronary lesions

Patients: 238 patients with stable or unstable angina.

Interventions: Randomisation to sirolimus eluting stent or bare stent implantation.

Main outcome measures: Patients were followed up to one year and the treatment effects were expressed as one year survival free of major adverse cardiac events (MACE). Costs were estimated as the product of resource utilisation and Dutch unit costs.

Results: At one year, the absolute difference in MACE-free survival was 23% in favour of the sirolimus eluting stent group. At the index procedure, sirolimus eluting stent implantation had an estimated additional procedural cost of 1286. At one year, however, the estimated additional cost difference had decreased to 54 because of the reduction in the need for repeat revascularisations in the sirolimus group (0.8% v 23.6%; p < 0.01). After adjustment of actual results for the consequences of angiographic follow up (correction based on data from the BENESTENT (Belgium Netherlands stent) II study), the difference in MACE-free survival was estimated at 11.1% and the additional one year costs at 166.

Conclusions: The one year data from RAVEL suggest an attractive balance between costs and effects for sirolimus eluting stents in the treatment of single native de novo coronary lesions. The cost effectiveness of drug eluting stents in more complex lesion subsets remains to be determined.

Abbreviations: ARTS, arterial revascularisation therapies study; BENESTENT, Belgium Netherlands stent; DEBATE, Doppler endpoints balloon angioplasty trial Europe; MACE, major adverse cardiac events; RAVEL, randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions

Keywords: stent; restenosis; cost effectiveness

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