Drug-eluting Stents And Metal Bare Stents After Implantation And Cost-effectiveness Studies

In recently years, the incidence of coronary heart disease (CHD) has increased obviously as the improvement of living standard. With the world economy and technology development, the coronary heart disease treatment had been developed from simple drug therapy to coronary artery interventional therapy. Because of remarkable treatment effect with Bare Mental Stent (BMS), the treatment method has been widely used in large population. However, drug-eluting stents (DES) exit owing to restenosis of coronary artery, which can reduce the target lesion revascularization (TLR) ratio. At the same time, as to be a chronic disease, the people realize that the improvement of the quality of life (QOL) can help to evaluate the effect of treatment. The major adverse cardiac event (MACE) between two arms, quality of life between pre-operation and post operation with Seattle Angina Questionnaire (SAQ), medical expense between two groups have been compared within this study. All results of study will provide the suggestion to clinical medical guideline and medical insurance policy.Objective:After screening170patients from two shanghai local hospitals, the baseline data and cardiac events after stents implanted between DES arm were compared, which to make a judgment of2arms in clinical follow up. Compare2arms in quality of life improvement with SAQ score. Compare medical expense of2arms including inpatient expense, follow up expense. To judge the advantage of expense-effectiveness in2groups according to between quality of life improvement and medical expense. All is helpful to provide evidence for DES application in clinical practice and suggestion of preferential policy to medical insurance policy.Methods:The study started from January2010to December2011in Shanghai2local hospitals. We screened the patients who need coronary artery intervention and stents implantation. In the end, totally170case was enrolled,96case DES and74case BMS respectively, and all patients have been followed up for6month. The demography data and baseline data were collected before enrolled. The type of stents, number of stents, concomitant medication, treatment& operation fee were also collected after subjects enrolled. The number of MACEs, medication, follow-up fee were collected within6month follow up. We compare MACEs, SAQ scores, medical expense between two groups by t test..Results:totally190pieces DES implanted in154lesion,140pieces BMS implanted in124lesions. All patients have been followed up. After6month following up,25%patients of DES arm occurred MACEs, and73%patients of BMS arm occurred MACEs. There is no difference in cardiovascular re-hospitalization ratio, myocardial infarction ratio and angiographic confirmed stent thrombosis ratio between2arms, significant difference exit in recurrent angina ratio (2.08%VS18.92%, p=0.000), Target Lesion Revascularization (TLR)(4.17%VS13.51%, p=0.046). There is also significant difference (p<0.001) between baseline and6month follow up in2arms for SAQ scores, indicating that the symptom of subjects have improved obviously after PCI. However there is no difference between2arms at baseline period and6month follow up period, indicating that two groups improve same degree. Compared to BMS group, DES group was significantly increased in hospitalization expenses (ï¿¥79,612.55VSï¿¥56,964.65), but at the end of follow-up period, owing to high ratio of target lesion revascularization, the BMS group higher expenses occurred (ï¿¥8,792.10VSï¿¥33,172.14, p=0.000). Finally, the whole expense (in-hospital expense and follow up expense) of BMS isï¿¥1,733higher than DES.Conclusion:The ratio of MACEs of BMS groups is higher than DES groups after6month follow up, but there is no significant difference between2arms in SAQ score. The total expense of DES is more advantage than BMS. As DES is more economic than BMS. So in short term DES has more advantage in the expense-effectiveness analysis than BMS.Policy suggestion:Though DES is much expensive as implanted into coronary artery at first time, so the first hospitalization expense is higher than BMS arm. However, the expense of BMS arm is higher than DES arm with short term follow up, as there is no difference of quality of life improvement, the DES is suggested to preferred use in medical insurance policy.