VIEWPOINT
Can we afford to eliminate restenosis?
Can we afford not to?
Dan Greenberg, PhD* ,
Ameet Bakhai, MD, MRCP* and
David J. Cohen, MD, MSc*,*
* Harvard Clinical Research Institute, Boston, Massachusetts, USA
Division of Cardiology, Beth Israel–Deaconess Medical Center, Boston, Massachusetts, USA
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.
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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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