An Economic Analysis of Drug Eluting Coronary Stents: A Québec Perspective

Heart disease, and particularly coronary artery disease, has a considerable burden of mortality and morbidity in Québec and elsewhere. The problem is often blockage (stenosis) of coronary arteries which can be treated by reduction of risk factors, various medications and revascularization. Restoration of coronary circulation was originally achieved by coronary bypass surgery, however in recent years less invasive techniques such as balloon angioplasty have been developed. This technique in- volves insertion of a small balloon via a catheter into the artery followed by expansion to open the blocked vessel and placement of metal stents to prevent restenosis. Stents are endoprostheses made of a fine cylindrical mesh of stainless steel placed inside coronary arteries to keep the affected sections of these vessels (dilated by balloon angioplasty) open.

A technological advance is the development of pharmaco-active stents which reduce risk of restenosis; however they do not reduce the risk of death or myocardial infarction compared to bare metal stents. These drug-eluting stents are being increasingly promoted but some controversy exists as to how many patients should receive these more effective, yet more expensive devices.

The analysis indicates that universal adoption of drug-eluting stents would significantly reduce rates of repeat revascularization interventions in Québec. However, under current epidemiological conditions and purchase costs it would represent a considerable budgetary investment for moderate benefits in terms of avoided revascularization interventions. Because of the relatively low rates of restenosis currently observed in Québec, a much more cost-effective strategy currently would support limited use of drug-eluting stents given to carefully selected high-risk patients across the province, with the remainder of patients continuing to receive bare metal stents.