A strategy to offset the extra cost of sirolimus-eluting stent in patients undergoing intervention for acute myocardial infarction

Objective To obtain a quantitative estimate of the overall costs and cost effectiveness ratio of sirolimus-eluting stents (SES) implantation and tirofiban infusion compared to abciximab and bare metal stent (BMS) in patients undergoing primary intervention for acute ST segment elevation myocardial infarction (STEMI). Methods In the attempt to make the unrestricted use of SES in STEMI patients affordable under the current European reimbursement system, between March 6, 2003, and April 23, 2004, 175 patients with STEMI were randomized to receive tirofiban infusion and SES versus abciximab and BMS as part of the STRATEGY trial. Costs and outcome were monitored for 2 years. Results The cost of the index procedure was €9345 ± 2573 and €9657 ± 2114 for the tirofiban + SES and abciximab + BMS group, respectively (P = 0.048). At follow-up, the composite of death or myocardial infarction and the costs not related to target vessel revascularisation (TVR) did not differ in the two groups while the rate of TVR and the costs related to it were lower in the tirofiban + SES group. The overall 2-year cost of treating a patient in the tirofiban + SES group was €10,971 ± 4185 compared to €12,066 ± 4636 for the abciximab + BMS group (P = 0.006). Halving the cost of abciximab resulted in higher initial hospital costs for the tirofiban + SES but overall cost neutrality over a 24-month time horizon. Conclusions Compared to abciximab + BMS, tirofiban infusion + SES implantation in STEMI patients was an economically dominant strategy, with an improved composite outcome and lower overall costs.