van Hout BA et al. (2005) 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. Heart 91: 507–512

Sirolimus-eluting stents are proven to provide clinical benefits for patients undergoing percutaneous coronary intervention, but are more costly than bare-metal stents. A group from the Netherlands has evaluated whether the lower reintervention rates observed in recipients of sirolimus-eluting stents balance the higher initial cost of treatment.

van Hout and colleagues analyzed data from the RAVEL multicenter randomized double-blind trial, comparing the incidence of major adverse cardiac events (all-cause death, nonfatal myocardial infarction, and surgical or percutaneous target lesion revascularization) in 238 patients receiving either sirolimus-eluting or bare-metal stents for treatment of single native de novo coronary lesions. Use of a sirolimus-eluting stent increased the cost of the initial procedure by €1,286 (∼US$1607) compared with bare-metal stents; however, after 1 year, the additional cost was reduced to €54 (∼$67), as a result of the reduced need for repeat revascularizations.

Since the RAVEL study included a follow-up angiogram at 5–7 months, which is not routine practice, the analysis was adjusted using subgroup data from the BENESTENT II trial, which compared costs of stenting with and without angiographic follow-up. The adjusted additional 1-year cost of using a sirolimus-eluting stent without routine angiographic follow-up was €166 (∼$207).

The authors note that actual costs will vary between centers, and that cost-effectiveness is strongly dependent on the relative price difference between the two types of stent, which differs between countries. They also suggest that these estimates might not apply to patient groups with a higher risk of reintervention, or more complex lesions.