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J Am Coll Cardiol, 2004; 43:513-518, doi:10.1016/j.jacc.2003.11.020
© 2004 by the American College of Cardiology Foundation
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VIEWPOINT

Can we afford to eliminate restenosis?

Can we afford not to?

Dan Greenberg, PhD*{dagger}, Ameet Bakhai, MD, MRCP*{dagger}{ddagger} and David J. Cohen, MD, MSc*{dagger},*

* Harvard Clinical Research Institute, Boston, Massachusetts, USA
{dagger} Division of Cardiology, Beth Israel–Deaconess Medical Center, Boston, Massachusetts, USA
{ddagger} Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, United Kingdom

Manuscript received August 4, 2003; revised manuscript received November 6, 2003, accepted November 13, 2003.

* Reprint requests and correspondence: Dr. David J. Cohen, Cardiovascular Division, Beth Israel–Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.
dcohen{at}caregroup.harvard.edu

Over the past decade, coronary stenting has emerged as the dominant form of percutaneous coronary revascularization. However, bare metal stents remain limited by a high incidence of restenosis, leading to frequent repeat revascularization procedures and substantial economic burden. Antiproliferative drug-eluting stents (DES) have recently demonstrated dramatic reductions in rates of restenosis, compared with conventional stenting, but important concerns about their costs have been raised. In this article, we summarize current evidence on the economic impact of restenosis and explore the potential benefits and economic outcomes of DES. In addition to examining the long-term costs of this promising technology, we consider the potential cost-effectiveness of DES from a health care system perspective and the impact of specific patient, lesion, and provider characteristics on these parameters.

Abbreviations and Acronyms
  BMS = bare metal stent(s)
  CABG = coronary artery bypass graft surgery
  CAD = coronary artery disease
  DES = drug-eluting stent(s)
  DRG = diagnosis-related group
  PCI = percutaneous coronary intervention
  QALY = quality-adjusted life-year
  QOL = quality of life
  TVR = target vessel revascularization




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