Cost effectiveness of drug-eluting stents in acute myocardial infarction patients in Germany: Results from administrative data using a propensity score-matching approach

被引：7

作者：

Bumler M. ^{[1
]}

Stargardt T. ^{[2
,3
]}

Schreygg J. ^{[2
,3
]}

Busse R. ^{[1
]}

机构：

[1] Department of Health Care Management, Berlin University of Technology, Berlin, Germany, 10623 Berlin

[2] Hamburg Centre for Health Economics, Hamburg University, Hamburg

[3] Institute of Health Economics and Health Care Management, Helmholtz Zentrum Mnchen, German Research Center for Environmental Health, Neuherberg

来源：

Applied Health Economics and Health Policy | 2012年 / 10卷 / 4期

关键词：

Cost-effectiveness; Drug-eluting-stents; Myocardial-infarction;

D O I：

10.2165/11597340-000000000-00000

中图分类号：

学科分类号：

摘要：

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 h12 714 and h11 714 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 -h718 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. © 2012 Springer International Publishing AG. All rights reserved.

引用

页码：235 / 248

页数：13

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