New and old strategies to afford the liberal use of drug-eluting stents in real-life scenarios

Drug-eluting stents represent one of the most important improvements in interventional cardiology by decreasing the rate of restenosis dramatically. However, at present, cost constraints and a lack of incremental reimbursement have limited their utilization in daily practice in many countries, including Europe. Strategies to implement the liberal use of sirolimus-eluting stents (SES), especially in the primary percutaneous coronary intervention setting where the cost-effectiveness profile could be less favourable, without affecting medical expenditure are presented and discussed. To project the potential cost-effectiveness of SES-supported multivessel treatment compared with that of coronary artery bypass grafting, a decisionanalytical model was developed from a payer’s perspective on the basis of data derived from the current Italian health-care system.