Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-27T01:12:28.165Z Has data issue: false hasContentIssue false
  • English
  • Français

Empirical assessment of the impact of drug-eluting stents on the rate of use of coronary revascularization procedures

Published online by Cambridge University Press:  01 August 2004

Roberto Grilli  and
Francesco Taroni
Roberto Grilli
Affiliation:
Agenzia Sanitaria Regionale of Emilia Romagna
Francesco Taroni
Affiliation:
Agenzia Sanitaria Regionale of Emilia Romagna
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To assess the impact of the availability of drug-eluting stents (DES) in April 2002 in Emilia-Romagna (a four-million resident Italian region), on the rate of use of revascularization procedures. DES are expected to influence the rate of use of coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI). However, to date, little empirical information is available on the actual impact of this innovation on clinical practice.

Methods: A time series regression analysis of the monthly number of procedures (PCI and CABG) performed between January 1998 and March 2003.

Results: DES availability was associated with statistically significant changes in the use of revascularization procedures, although the size of the effect was always small or moderate. PCI increased only by 0.36 more procedures per month (approximately four per year), whereas more evident was the concurrent reduction of isolated CABG (4.15 fewer per month, that is fifty fewer per year). Overall, considering all the surgical revascularizations (i.e., CAGB both isolated and associated with other interventions), there was a reduction of 2.52 procedures per month (thirty less per year).

Conclusions: Despite DES being at a very early stage of their diffusion process, our results indicate that they are already having an impact, although moderate, on the use of revascularization procedures. If these findings will be confirmed, they will have a substantial influence on the patterns of care for patients with coronary artery disease and relevant policy implications for health services.

Keywords

Patterns of careCoronary artery bypassPercutaneous coronary interventionsDrug-eluting stentsTime series analysis
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 3 , August 2004 , pp. 356 - 360
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Babapulle MN, Eisenberg MJ. 2002; Coated stents for the prevention of restenosis: I. Circulation. 106: 2734– 2740.Google Scholar
Babapulle MN, Eisenberg MJ. 2002; Coated stents for the prevention of restenosis: II. Circulation. 106: 2859– 2866.Google Scholar
Cook TD, Campbell DT. 1979 Quasi-experimentation: Design and analysis issues for field settings. Boston: Houghton Mifflin Company
Draper N, Smith H. 1981 Applied regression analysis. New York: Wiley
Ferreira AC, Peter AA, Salerno TA, Bolooki H, de Marchena E. 2003 Clinical impact of drug-eluting stents in changing referral practices for coronary surgical revascularization in a tertiary care center. Ann Thorac Surg. 75: 485– 489.Google Scholar
Filardo G, Maggioni AP, Mura G, et al. 2001 The consequences of under-use of coronary revascularization. Results of a cohort study in Northern Italy. Eur Heart J. 22: 654– 662.Google Scholar
Halm EA, Lee C, Chassin MR. 2002 Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 137: 511– 520.Google Scholar
Marx SO, Marks AR. 2001 The development of rapamycin and its application to stent restenosis. Circulation. 104: 852– 855.Google Scholar
Morice MC, Serruys PW, Sousa JE, et al. 2002 A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 346: 1773– 1780.Google Scholar
O'Neil D, Miles A, Polychronis A. 1996 Central dimensions of clinical practice evaluation: Efficiency, appropriateness and effectiveness. I. J Eval Clin Pract. 2: 13– 27.Google Scholar
Powell AE, Davies HTO, Thomson RG. 2003 Using routine comparative data to assess the quality of health care: Understanding and avoiding common pitfalls. Qual Saf Health Care. 12: 122– 128.Google Scholar
Ramsay CR, Matowe L, Grilli R, Grimshaw JM, Thomas RE. 2003 Interrupted time series design in implementation research: Lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care. 19: 613– 623.Google Scholar
Rensing BJ, Vos J, Smits PC, et al. 2001 Coronary restenosis elimination with a sirolimus eluting stent. Eur Heart J. 22: 2125– 2130.Google Scholar
Sousa JE, Costa MA, Abizaid AC, et al. 2001 Sustained suppression of neointimal proliferation by sirolimus-eluting stents. One-year angiographic and intravascular ultrasound follow-up. Circulation. 104: 2007– 2011.Google Scholar