title: Cost-effectiveness of paclitaxel-coated balloon angioplasty in patients with drug-eluting stent restenosis.
abstract: BACKGROUND
  The economic impact of drug-eluting stent (DES) in-stent restenosis (ISR) is substantial, highlighting the need for cost-effective treatment strategies.
  
  
  OBJECTIVE
  Compared to plain old balloon angioplasty (POBA) or repeat DES implantation, drug-coated balloon (DCB) angioplasty is a cost-effective therapy for DES-ISR.
  
  
  METHODS
  A Markov state-transition model was used to compare DCB angioplasty with POBA and repeat DES implantation. Model input parameters were obtained from the literature, and the cost analysis was conducted from a German healthcare payer's perspective. Extensive sensitivity analyses were performed.
  
  
  RESULTS
  Initial procedure costs amounted to €3488 for DCB angioplasty and to €2782 for POBA. Over a 6-month time horizon, the DCB strategy was less costly (€4028 vs €4169) and more effective in terms of life-years (LYs) gained (0.497 versus 0.489) than POBA. The DES strategy incurred initial costs of €3167 and resulted in 0.494 LYs gained, at total costs of €4101 after a 6-month follow-up. Thus, DCB angioplasty was the least costly and most effective strategy. Base-case results were influenced mostly by initial procedure costs, target lesion revascularization rates, and the costs of dual antiplatelet therapy.
  
  
  CONCLUSIONS
  DCB angioplasty is a cost-effective treatment option for coronary DES-ISR. The higher initial costs of the DCB strategy compared to POBA or repeat DES implantation are offset by later cost savings.
authors.affiliation: Department of Cardiology, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. marc.dorenkamp@charite.de
authors.forename: Marc
authors.initials: M
authors.lastname: Dorenkamp
authors.forename: Julia
authors.initials: J
authors.lastname: Boldt
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: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.forename: Klaus
authors.initials: K
authors.lastname: Bonaventura
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D062906:Cardiac Catheters / Q000191:economics*; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000191:economics*; D020099:Coated Materials, Biocompatible / Q000191:economics*; D023903:Coronary Restenosis / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004337:Drug Carriers / Q000191:economics*; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics*; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009010:Monte Carlo Method; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics*; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; D004337:Drug Carriers; D010975:Platelet Aggregation Inhibitors; D017239:Paclitaxel