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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

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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.

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Conflict of interest

K.B. and F.X.K. have received lecture and consulting fees from B. Braun. The remaining authors have no disclosures.

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Authors and Affiliations

  1. Department of Cardiology, Angiology, and Conservative Intensive Care Medicine, Heart, Thorax and Vascular Center, Klinikum Ernst von Bergmann, Charlottenstrasse 72, 14467, Potsdam, Germany

    Klaus Bonaventura & Franz X. Kleber

  2. Sports Medicine and Sports Orthopaedics, University Outpatient Clinic Potsdam, University of Potsdam, Potsdam, Germany

    Klaus Bonaventura

  3. Department of Cardiology, Heart Center Bogenhausen, Städtisches Klinikum München, Munich, Germany

    Alexander W. Leber

  4. Department of Cardiology and Pneumology, Heart Center, Georg-August-University of Göttingen, Göttingen, Germany

    Christian Sohns

  5. Department of Cardiology, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Mattias Roser, Leif-Hendrik Boldt, Wilhelm Haverkamp & Marc Dorenkamp

  6. Strategic Business Development, Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany

    Marc Dorenkamp

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  1. Klaus Bonaventura
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Correspondence to Klaus Bonaventura.

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Bonaventura, K., Leber, A.W., Sohns, C. et al. 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. Clin Res Cardiol 101, 573–584 (2012). https://doi.org/10.1007/s00392-012-0428-2

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