Background Use of DES when performing percutaneous coronary intervention (PCI) for stable angina reduces the risk of reintervention, but increases health care costs. Previous economic analyses may indicate that DES offer value for money, but the analyses have been based on a limited number of clinical trials and short follow-up periods.

Methods We developed a Markov model which captures costs and outcomes the first two years after PCI with stent for stable angina. After each PCI, patients can either become well, have a new intervention (PCI og CABG) or die. The model was based on meta-analyses of trials comparing DES with BMS. The relative risk of reintervention was 86%, 49%, 38% and 36% lower at 1, 6, 12 and 24 months follow-up when using DES instead of BMS. We assumed that DES will reduce mortality because of fewer intervention related deaths, but also explored a potential increased mortality because the meta-analysis indicates a non-significant trend towards increased mortality of DES compared to BMS. One-way and Monte-Carlo sensitivity analyses were applied.

Results The estimated cost per avoided reintervention was $ 5,000 when BMS was replaced by DES, ranging from $200 to $16,000 in one-way sensitivity analyses. The price of a drug eluting stent would have to be reduced from currently $2,000 to $1,400 to make the use of DES cost saving compared to BMS (current purchasing price $ 560).

The estimated cost per life year gained and quality adjusted life year gained were $121,000 and $46,000, respectively, when increased mortality was disregarded in the model. Probabilistic sensitivity analysis indicated a 64% probability that drug eluting stents were cost-effective if society is willing to pay $50,000 for one quality adjusted life year.

When the increased mortality was included, BMS was the dominant strategy, with both lower costs and greater life expectancy.

Conclusions In a two-year perspective, the DES strategy resulted in greater costs than the BMS-strategy with any realistic combination of model parameters. Cost-effectiveness of DES depended heavily on purchasing price of the stents, risk of restenosis and rate of reintervention in routine practice.