title: Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease.
abstract: BACKGROUND
  Recent studies have demonstrated the safety and efficacy of drug-coated balloon (DCB) angioplasty for the treatment of coronary in-stent restenosis (ISR). The cost-effectiveness of this practice is unknown.
  
  
  METHODS
  A Markov state-transition decision analytic model accounting for varying procedural efficacy rates, complication rates, and cost estimates was developed to compare DCB angioplasty with drug-eluting stent (DES) placement in patients with bare-metal stent (BMS)-ISR. Data on procedural outcomes associated with both treatment strategies were derived from the literature, and the cost analysis was conducted from a health care payer perspective. Effectiveness was expressed as life-years gained.
  
  
  RESULTS
  In the base-case analysis, initial procedure costs amounted to €3,604.14 for DCB angioplasty and to €3,309.66 for DES implantation. Over a 12-month time horizon, the DCB strategy was found to be less costly (€4,130.38 vs. €5,305.30) and slightly more effective in terms of life expectancy (0.983 vs. 0.976 years) than the DES strategy. Extensive sensitivity analyses indicated that, in comparison with DES implantation, the cost advantage of the DCB strategy was robust to clinically plausible variations in the values of key model input parameters. The variables with the greatest impact on base-case results were the duration of dual antiplatelet therapy with acetylsalicylic acid and clopidogrel after DCB angioplasty, the use of generic clopidogrel, and variations in the costs associated with the DCB device.
  
  
  CONCLUSIONS
  DCB angioplasty is a cost-effective treatment option for coronary BMS-ISR. The higher initial costs of DCB are more than offset by later cost-savings, predominantly as a result of reduced medication costs.
authors.affiliation: Department of Cardiology, Angiology, Klinikum Ernst von Bergmann, Potsdam, Germany. kbonaventura@klinikumevb.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Bonaventura
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.forename: Mattias
authors.initials: M
authors.lastname: Roser
authors.forename: Leif-Hendrik
authors.initials: LH
authors.lastname: Boldt
authors.forename: Franz X
authors.initials: FX
authors.lastname: Kleber
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.forename: Marc
authors.initials: M
authors.lastname: Dorenkamp
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000191:economics*; D057785:Catheters / Q000191:economics*; D020099:Coated Materials, Biocompatible / Q000191:economics*; D003198:Computer Simulation; D003324:Coronary Artery Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy; D023903:Coronary Restenosis / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics*; D004867:Equipment Design; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008670:Metals; D018803:Models, Economic; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics*; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; D008670:Metals; D010975:Platelet Aggregation Inhibitors; D017239:Paclitaxel