BMS or DES for CAD Patients: Balancing Between Economic and Clinical Outcomes

Presenter: Yi-Ling Lin, Kaohsiung Medical University

Abstract

Purpose: Coronary artery disease (CAD) was ranked as top 2 of ten leading death causes at 2004 in Taiwan. Technology of percutaneous coronary intervention (PCI) is advancing, especially after the introduction of Bare Mental Stent (BMS), and drug-eluting stents (DES). No clinical and economic utilization information between two stents has been disclosed in Taiwan. The purpose of the study is to conduct effectiveness and economic utilization between BMS and DES.

Methods: This quesi-expermental study design was used at this study. From July 2003 to Feb. 2005, 173 BMS patients and 173 DES patients were retrospectively recruited. Clinical outcomes and economic utilization were collected for all patients over one year after the PCI. Clinical outcomes included four MACE (Major Adverse Cardiac Event) indicators: cause of death, acute myocardial infarction (AMI), congestive heart failure (CHF) and target lesion revascularization (TLR). Economic utilization indicators included out-patient visits, re-hospitalization.

Results: One year after the PCI, the MACE rate for the BMS group was 30.63%, while DES was 18.49%, respectively (p value = 0.004). Specifically, the event for death, AMI, CHF and TLR were 1.73%, 1.16%, 7.51% and 20.23%, for BMS group, while for DES were 0.57%, 2.31%, 6.35% and 9.25%. With respect to the healthcare economic utilization indicators, no statistically significance was found. The BMS group had 8.96 out-patient visits over one year period, and 0.61 CAD related re-hospitalization. For the DES group, had 8.38 out-patient visits, and 0.61 re-hospitalization. Multivariate analysis demonstrated that BMS group and multiple vessels disease were the significant predictors of TLR.

Conclusion: The findings support that DES, the most advancing PCI technology, is much better in clinical outcome, as compared with BMS. Although, no difference in healthcare utilization over one year, the price of DES was triple that of BMS. The finding implies the dilemmas of balancing between cost and effectiveness.