Abstract

CEBALLOS, Mateo. Economic evaluation of medicated stent vs. standard stent for patients with acute myocardial infarction with ST elevation in Colombia. Rev. Colomb. Cardiol. [online]. 2014, vol.21, n.6, pp.364-371. ISSN 0120-5633.  https://doi.org/10.1016/j.rccar.2014.06.005.

Objective: To perform a cost-effectiveness and value of perfect information analysis comparing sirolimus-eluting stent with bare metal stent for patients with ST-segment elevation myocardial infarction in Colombia. Methods: We developed a Markov model from the payer perspective and considering a time horizon of 10 years in the base case. Transition probabilities were extracted from clinical studies identified from literature reviews. Costs were estimated using expert consensus and Colombian tariff handbooks. We performed a deterministic analysis around the time horizon, the discount rate and the price of the drug eluting stent. We developed a probabilistic sensitivity analysis (10,000 Monte Carlo simulations) and a value of perfect information analysis for the global decision and parameter groups. Results: In the base case, the cost per quality adjusted life year gained was $ 53,749,654. The results are sensitive to the drug eluting stent price, but not to the time horizon and the discount rate. The expected value of perfect information was significantly higher for the probability of death and very late stent thrombosis. Conclusions: Sirolimus-eluting stent is not cost-effective for patients with an ST segment elevation myocardial infarction. More future research is recommended around the risk of death and very late stent thrombosis, as well as in specific subgroups of patients and second-generation drug-eluting stents.

Keywords : Cost-effectiveness analysis; Health economic evaluation; Drug eluting stent; ST-elevation myocardial infarction.

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