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Cost Effectiveness of Drug-Eluting Stents in Acute Myocardial Infarction Patients in Germany

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  • Michael Bäumler
  • Tom Stargardt
  • Jonas Schreyögg
  • Reinhard Busse

Abstract

Background: The high number of patients with acute myocardial infarction (AMI) has facilitated greater research, resulting in the development of innovative medical devices. So far, results from economic evaluations that compared drug-eluting stents (DES) and bare-metal stents (BMS) have not shown clear evidence that one intervention is more cost effective than the other. Objective: The aim of this study was to measure the cost effectiveness of DES compared with BMS in routine care. Methods: We used administrative data from a large German sickness fund to compare the costs and effectiveness of DES and BMS in patients with AMI. Patients with hospital admission after AMI in 2004 and 2005 were followed up for 1 year after hospital discharge. The cost of treatment and survival after 365 days were compared for patients treated with DES and BMS. We adjusted for covariates defined according to the Ontario Acute Myocardial Infarction Mortality Prediction Rules using propensity score matching. After matching, we calculated incremental cost-effectiveness ratios (ICERs) by (i) using sample means based on bootstrapping procedures and (ii) estimating generalized linear mixed models for costs and survival. Results: After propensity score matching, the sample included 719 patients treated with DES and 719 patients treated with BMS. A comparison of sample means resulted in average costs of €12 714 and €11714 for DES and BMS, respectively, in 2005 German euros. Difference in 365-day survival was not statistically significant (700 patients with DES and 701 with BMS). The ICER of DES versus BMS was −€718 709 per life saved. Bootstrapping resulted in DES being dominated by BMS in 54.5% of replications and DES being a dominant strategy in 2.7% of replications. Results from regression models and sensitivity analyses confirm these results. Conclusion: Treatment with DES after admission with AMI is less cost effective than treatment with BMS. Our results are in line with other cost-effectiveness analyses that used administrative data, i.e. under routine care conditions. However, our results do not preclude that DES may be cost effective in specific patient subgroups. Copyright Springer International Publishing AG 2012

Suggested Citation

  • Michael Bäumler & Tom Stargardt & Jonas Schreyögg & Reinhard Busse, 2012. "Cost Effectiveness of Drug-Eluting Stents in Acute Myocardial Infarction Patients in Germany," Applied Health Economics and Health Policy, Springer, vol. 10(4), pages 235-248, July.
    • Handle: RePEc:spr:aphecp:v:10:y:2012:i:4:p:235-248
    DOI: 10.2165/11597340-000000000-00000
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    References listed on IDEAS

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    1. Cutler, David M., 2007. "The lifetime costs and benefits of medical technology," Journal of Health Economics, Elsevier, vol. 26(6), pages 1081-1100, December.
    2. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann & Reinhard Busse, 2006. "Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries," Health Care Management Science, Springer, vol. 9(3), pages 215-223, August.
    3. Cutler, David, 2007. "The Lifetime Costs and Benefits of Medical Technology," Scholarly Articles 2643640, Harvard University Department of Economics.
    4. Mattias Neyt & Chris Laet & Annemieke Ridder & Hans Brabandt, 2009. "Cost Effectiveness of Drug-Eluting Stents In Belgian Practice," PharmacoEconomics, Springer, vol. 27(4), pages 313-327, April.
    5. Dennis D. Boos & Leonard A. Stefanski & Yujun Wu, 2009. "Fast FSR Variable Selection with Applications to Clinical Trials," Biometrics, The International Biometric Society, vol. 65(3), pages 692-700, September.
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    Cited by:

    1. Tamara Schmid, 2015. "Costs of treating cardiovascular events in Germany: a systematic literature review," Health Economics Review, Springer, vol. 5(1), pages 1-11, December.
    2. James Lomas & Miqdad Asaria & Laura Bojke & Chris P. Gale & Gerry Richardson & Simon Walker, 2018. "Which Costs Matter? Costs Included in Economic Evaluation and their Impact on Decision Uncertainty for Stable Coronary Artery Disease," PharmacoEconomics - Open, Springer, vol. 2(4), pages 403-413, December.

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