Análise do custo-efetividade do uso do stent farmacológico vs. stent não farmacológico na intervenção coronariana percutânea uniarterial no Sistema Único de Saúde

Abstract

Patients who underwent coronary angiography using the Brazilian Public Health System (SUS) and who present with coronary artery disease (CAD) with severe obstruction may have an indication of percutaneous coronary intervention (PCI) with stent implantation, depending on angina or myocardial ischemia documented by diagnostic studies. Due to the costs of drug eluting stent (DES), the reality of SUS requires that most of these patients be treated with bare metal stent (BMS). Many of them present with complex lesions or comorbidities whose late results would be superior with the DES when compared to those obtained with BMS, especially with regard to restenosis. In the present study, 231 patients (DES=77 and BMS=154) were randomized in a 1:2 ratio, and 215 patients (DES=74 and BMS=141) were followed up for one year, with subsequent prospective analysis. The results were: in the DES group, stent restenosis was 1.4% (n=1), target lesion revascularization: (TLR) 1.4% (n=1), no cases of stent thrombosis (n=0) and death: 1.4% (n=1). In the BMS group, stent restenosis was 10.1% (n=14), target lesion revascularization: 7.3% (n=10), stent thrombosis: 0.74% (n=1), and death: 2.1% (n=3). From these clinical results, the economic analysis and estimated incremental cost-effectiveness ratio (ICER) were performed, due to avoided restenosis in both groups. In the economic analysis, the cost of the procedure considering avoided restenosis was R$5 722,21 in the DES group and R$4 085,21 in the BMS group. The difference in effectiveness in favor of the DES group was 8.7%, with an ICER of R$18 816,09. In conclusion, PCI with DES compared to BMS was not superior in relation to major adverse events (infarction, death), although related to a lower rate of restenosis and target lesion revascularization. Considering the values paid by the SUS for BMS, the DES is cost-effective in relation to the avoided restenosis.