Abstract

OBJECTIVE
To quantify the economic value of the Sirolimus Eluting Stent (CYPHER(TM)) in treating acute coronary heart disease (CHD), and to assist in determining an adequate level of reimbursement for CYPHER(TM) in Korea. METHODS: A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of CYPHER(TM) versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization. The follow-up costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Depending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were performed for discount rates of 3, 5 and 7%. Since the major clinical advantage of CYPHER(TM) over conventional stenting was the reduction in the revascularization rates, the economic value of CYPHER(TM), in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of CYPHER(TM) per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, CYPHER(TM) would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of CYPHER(TM) making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. RESULTS: The average weighted initial insurance covered and total medical costs of conventional stenting were about 6, 275, 000 and 8, 058, 000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13, 659, 000 and 17, 353, 000 Won, respectively. The estimated maximum level of reimbursement price of CYPHER(TM) from the perspectives of the insurer and society were 4, 126, 897 ~ 4, 325, 161 and 4, 939, 939 ~ 5, 078, 781 Won, respectively. CONCLUSION: By evaluating the economic value of CYPHER(TM), as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for CYPHER(TM).

• Keywords: Coronary heart diseaseCost effectivenessDecision analysisStents