OBJECTIVES: The design of coronary stents continues to evolve with the intention to reduce short- and long-term adverse events. The recent BIOFLOW V trial (ClinicalTrials.gov: NCT02389946) showed a lower rate of peri-procedural myocardial infarction (ppMI) for the latest generation Orsiro ultrathin, bioresorbable polymer sirolimus-eluting stent (BPSES) (BIOTRONIK, Buelach, Switzerland) than for the industry leading Xience thin, durable polymer everolimus-eluting stent (DPEES) (Abbott Vascular, Santa Clara, CA). We used a Markov model to project clinical and cost outcomes of that lower ppMI rate from a U.S. payer perspective over a 12-month horizon.

METHODS: Model parameters were derived from BIOFLOW V trial data, a systematic literature review and expert interviews. Absolute risk reduction of ppMI rates was 1.66 to 2.18 percentage points for BPSES compared to DPEES (p<0.05). For ppMI patients, we assumed incremental cost of $5,243 (range: $0-$7,531) during admission for initial stent placement, of $446 (range: $0-$17,918) during 12 months post discharge and an adjusted hazard ratio for mortality of 1.20 (range: 1.00-2.1) based on published estimates. Cost estimates were CPI-adjusted to 2018 US$.

RESULTS: We estimate that use of BPSES compared to DPEES is associated with net reductions in medical cost of $94-124 per patient, of which $87-115 accrues to the initial admission and $7-10 to cost of follow-up. An estimated gain of 19-21 quality-adjusted life-years (QALY) in 1 million patients yields an additional economic benefit of $1.7-2.1 per patient for BPSES, when valuing one QALY gained at $100,000. In a probabilistic sensitivity analysis, 63% of 100,000 model runs show net savings for BPSES.

CONCLUSIONS: The analysis suggests that BPSES dominates DPEES, as it reduces cost while improving patient outcomes. With about 600,000 stent procedures performed in the U.S. each year, annual savings could add up to $56-74 million and over 90% of the savings would accrue during the index admission.