We investigated the clinical and economic impact of sirolimus-eluting coronary stents (SES) at a nationwide level as to advice about the feasible reimbursement policy for the Italian Health Care System (SSN). A de-cision model compared bare metal stents (BMS) and SES in terms of costs and repeat coronary revascularizations incurred in 12 months following the first revasculariza-tion. The model was compiled for eight sub-groups of patients. Rates of events were de-rived from randomized trials and an 1,809-patient survey. National charges were used to evaluate resources consumption. Com-pared with BMS, the number of averted revascularizations with SES is 0.16 per pa-tient. SES also save €1,371 per patient. Total savings to SSN are proportional to the rate of SES adoption by Italian hospitals: assum-ing a complete replacement of BMS with SES, the model estimates that 7,095 revascu-larizations would be averted and more than €60 million saved by the SSN in 1 year. To stimulate SES adoption a SES-specific DRG might by introduced with a reimbursement value 23% higher than the current charge. SES is thus a cost-saving strategy in the per-spective of the SSN that could therefore sup-port the introduction of the new technolo-gy by reimbursing about 80% of its current incremental acquisition cost.
What reimbursement for coronary revascularisation with drug-eluting stents
TARRICONE, ROSANNA;
2004
Abstract
We investigated the clinical and economic impact of sirolimus-eluting coronary stents (SES) at a nationwide level as to advice about the feasible reimbursement policy for the Italian Health Care System (SSN). A de-cision model compared bare metal stents (BMS) and SES in terms of costs and repeat coronary revascularizations incurred in 12 months following the first revasculariza-tion. The model was compiled for eight sub-groups of patients. Rates of events were de-rived from randomized trials and an 1,809-patient survey. National charges were used to evaluate resources consumption. Com-pared with BMS, the number of averted revascularizations with SES is 0.16 per pa-tient. SES also save €1,371 per patient. Total savings to SSN are proportional to the rate of SES adoption by Italian hospitals: assum-ing a complete replacement of BMS with SES, the model estimates that 7,095 revascu-larizations would be averted and more than €60 million saved by the SSN in 1 year. To stimulate SES adoption a SES-specific DRG might by introduced with a reimbursement value 23% higher than the current charge. SES is thus a cost-saving strategy in the per-spective of the SSN that could therefore sup-port the introduction of the new technolo-gy by reimbursing about 80% of its current incremental acquisition cost.
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