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. Hypothesis: 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. IntroductionRestenosis after coronary stent implantation remains a significant clinical problem. Even after deployment of a drug-eluting stent (DES), it occurs in 10% to 15% of patients. 1 -3 Given its incidence and related morbidity, the economic impact of DES in-stent restenosis (ISR) is substantial, highlighting the need for cost-effective treatment strategies.The available nonsurgical treatment options for the management of DES-ISR include balloon angioplasty, the use of a cutting or scoring balloon, vascular brachytherapy, and repeat stenting. 4 Currently, repeat DES implantation

Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

“…A large registry demonstrated that TLR after PCB was 9.6% at 9 months in 464 patients with 482 DES restenoses [26]. Given its higher cost [27], however, patient selection is important. In select patients using OCT imaging (focal lesion with heterogeneous pattern by OCT), simple balloon dilatation could be a possible treatment strategy.…”

Study on the safety and effectiveness of drug-coated balloons in patients with acute myocardial infarction

“…Considering the cost, DCB also met reasonable expectations. Currently, Dorenkamp [27] found that during the six-month follow-up period, the total cost of the DCB treatment strategy was lower than the total cost of the DES treatment (4,028 euros versus 4,101 euros). At the same time, compared with DES, DCB can effectively extend the life of patients (0.497 vs. 0.494).…”

Clinical Outcomes of Biodegradable Polymer Drug‐Eluting Stents for Percutaneous Coronary Intervention: An Updated Meta‐analysis of Randomized Controlled Trials

“…Findings from ongoing studies including STACCATO (Stent sTrut Apposition and Coverage in Coronary ArTeries: an Optical Coherence Tomography (OCT) Study) (BioMatrix [Biosensors Interventional Technologies Pte Ltd, Singapore] vs Xience V [Abbott Vascular, Abbott Laboratories, Abbott Park, Illinois, USA]) and ISAR‐TEST 6 (Intracoronary Stenting and Angiographic Results: Test Efficacy of Biodegradable and Permanent Limus‐Eluting Stents‐6) (Nobori [Terumo Corporation, Tokyo, Japan] vs Xience V) are of substantial value and their publication is eagerly anticipated. PCI represents a huge market in interventional cardiology, and the economic impact of using newer devices should be acknowledged . Subsequent efforts in investigating the cost‐effectiveness of biodegradable polymer DES are also warranted.…”