Clinical Research in Cardiology

, Volume 101, Issue 7, pp 573–584

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

  • Klaus Bonaventura
  • Alexander W. Leber
  • Christian Sohns
  • Mattias Roser
  • Leif-Hendrik Boldt
  • Franz X. Kleber
  • Wilhelm Haverkamp
  • Marc Dorenkamp
Original Paper

DOI: 10.1007/s00392-012-0428-2

Cite this article as:
Bonaventura, K., Leber, A.W., Sohns, C. et al. Clin Res Cardiol (2012) 101: 573. doi:10.1007/s00392-012-0428-2

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.

Conclusion

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.

Keywords

Cost-effectiveness Drug-coated balloon Drug-eluting stent Restenosis Revascularization 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Klaus Bonaventura
    • 1
    • 2
  • Alexander W. Leber
    • 3
  • Christian Sohns
    • 4
  • Mattias Roser
    • 5
  • Leif-Hendrik Boldt
    • 5
  • Franz X. Kleber
    • 1
  • Wilhelm Haverkamp
    • 5
  • Marc Dorenkamp
    • 5
    • 6
  1. 1.Department of Cardiology, Angiology, and Conservative Intensive Care Medicine, Heart, Thorax and Vascular CenterKlinikum Ernst von BergmannPotsdamGermany
  2. 2.Sports Medicine and Sports Orthopaedics, University Outpatient Clinic PotsdamUniversity of PotsdamPotsdamGermany
  3. 3.Department of Cardiology, Heart Center BogenhausenStädtisches Klinikum MünchenMunichGermany
  4. 4.Department of Cardiology and Pneumology, Heart CenterGeorg-August-University of GöttingenGöttingenGermany
  5. 5.Department of CardiologyCharité, Universitätsmedizin BerlinBerlinGermany
  6. 6.Strategic Business DevelopmentCharité, Universitätsmedizin BerlinBerlinGermany

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