One year cost effectiveness of sirolimus eluting stents compared with bare metal stents in the treatment of single native de novo coronary lesions: an analysis from the RAVEL trial

Objective: To assess the balance between costs and effects of the sirolimus eluting stent in the treatment of single native de novo coronary lesions in the RAVEL ( randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions) study. Design: Multicentre, double blind, randomised trial Setting: Percutaneous coronary intervention for single de novo coronary lesions Patients: 238 patients with stable or unstable angina. Interventions: Randomisation to sirolimus eluting stent or bare stent implantation. Main outcome measures: Patients were followed up to one year and the treatment effects were expressed as one year survival free of major adverse cardiac events ( MACE). Costs were estimated as the product of resource utilisation and Dutch unit costs. Results: At one year, the absolute difference in MACE-free survival was 23% in favour of the sirolimus eluting stent group. At the index procedure, sirolimus eluting stent implantation had an estimated additional procedural cost of E1286. At one year, however, the estimated additional cost difference had decreased to E54 because of the reduction in the need for repeat revascularisations in the sirolimus group ( 0.8% v 23.6%; p