The disutility of restenosis--the impact of repeat percutaneous coronary intervention on quality of life.
BACKGROUND
Percutaneous coronary intervention (PCI) with coronary stenting is a common medical procedure that is used to treat the symptoms of both stable angina and acute coronary syndromes. Drugeluting stents (DES) decrease restenosis and repeat revascularization procedures but are more expensive than bare-metal stents. A proper cost-effectiveness analysis of DES requires an understanding of the health value patients place on the avoidance of restenosis accompanied by a repeat PCI.


OBJECTIVE
To estimate quality-of-life (QoL) benefits ascribed to avoiding the return of coronary symptoms and the need for a repeat revascularization procedure.


METHODS
A prospective, single-centre study was conducted involving PCI patients. A time trade-off (TTO) question, based on a hypothetical restricted lifespan of 10 years, was used to estimate the QoL benefits patients attach to the avoidance of recurrent symptoms and a repeat PCI. This was accomplished by interviewing the patients by telephone, two weeks post-PCI. The TTO question was also administered to the catheterization laboratory staff.


RESULTS
Between January and March 2007, and between April and June 2008, 103 interviews were completed. The median TTO was zero weeks (interquartile range zero to 1.7 weeks). Six interventional cardiologists and eight cardiac catheterization nurses reported a similar median disutility.


CONCLUSIONS
Despite acknowledgement of the substantial clinical benefits of DES, the results of the present study suggest that patients do not place a great disutility on avoiding restenosis, thereby providing little QoL justification for the large incremental cost associated with this technology.
Ploegmakers
Marleen M J
MM
Department of Epidemiology, Biostatistics and Health Technology Assessment, University Medical Centre Nijmegen, The Netherlands.
Viscaal
Anneke M
AM
Finch
Lois
L
Mayo
Nancy E
NE
Brophy
James M
JM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000523:psychology / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011792:Quebec / Q000453:epidemiology; D019233:Retreatment / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires