Evaluating the potential cost-effectiveness of stenting as a treatment for symptomatic single-vessel coronary disease: Use of a decision-analytic model

David J. Cohen, Jeffrey Breall, Kalon K L Ho, Richard E. Kuntz, Lee Goldman, Donald S. Baim, Milton C. Weinstein

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background: Coronary stenting appears to provide more predictable immediate results and lower rates of restenosis than conventional balloon angioplasty for selected lesion types, but its hospital costs are significantly higher. This study was designed to evaluate the potential cost- effectiveness of Palmaz-Schatz coronary stenting relative to conventional balloon angioplasty for the treatment of patients with symptomatic, single- vessel coronary disease. Methods and Results: We developed a decision- analytic model to predict quality-adjusted life expectancy and lifetime treatment costs for patients with symptomatic, single-vessel coronary disease treated by either Palmaz-Schatz stenting (PSS) or conventional angioplasty (PTCA). Estimates of the probabilities of overall procedural success (PTCA, 97%; PSS, 98%), abrupt closure requiring emergency bypass surgery (PTCA, 1.0%; PSS, 0.6%), and angiographic restenosis (PTCA, 37%; PSS, 20%) were derived from review of the literature published as of September 1993. Procedural costs were based on the true economic (ie, variable) costs of each procedure at Boston's Beth Israel Hospital. On the basis of these data, coronary stenting was estimated to result in a higher quality-adjusted life expectancy than conventional angioplasty but to incur additional costs as well. Compared with conventional angioplasty, stenting had an estimated incremental cost-effectiveness ratio of $23 600 per quality-adjusted life year gained. Although the cost-effectiveness ratio for stenting changed with variation in assumptions about the relative costs and restenosis rates, it remained less than $40 000 per quality-adjusted year of life gained-and thus was similar to many other accepted medical treatments-unless the stent angiographic restenosis rate was >23%, the angioplasty restenosis rate was

Original languageEnglish (US)
Pages (from-to)1859-1874
Number of pages16
JournalCirculation
Volume89
Issue number4
StatePublished - Apr 1994
Externally publishedYes

Fingerprint

Angioplasty
Cost-Benefit Analysis
Coronary Disease
Costs and Cost Analysis
Balloon Angioplasty
Quality-Adjusted Life Years
Life Expectancy
Quality of Life
Hospital Costs
Israel
Therapeutics
Health Care Costs
Stents
Emergencies
Economics

Keywords

  • angioplasty
  • cost-effectiveness
  • stents

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Cohen, D. J., Breall, J., Ho, K. K. L., Kuntz, R. E., Goldman, L., Baim, D. S., & Weinstein, M. C. (1994). Evaluating the potential cost-effectiveness of stenting as a treatment for symptomatic single-vessel coronary disease: Use of a decision-analytic model. Circulation, 89(4), 1859-1874.

Evaluating the potential cost-effectiveness of stenting as a treatment for symptomatic single-vessel coronary disease : Use of a decision-analytic model. / Cohen, David J.; Breall, Jeffrey; Ho, Kalon K L; Kuntz, Richard E.; Goldman, Lee; Baim, Donald S.; Weinstein, Milton C.

In: Circulation, Vol. 89, No. 4, 04.1994, p. 1859-1874.

Research output: Contribution to journalArticle

Cohen, David J. ; Breall, Jeffrey ; Ho, Kalon K L ; Kuntz, Richard E. ; Goldman, Lee ; Baim, Donald S. ; Weinstein, Milton C. / Evaluating the potential cost-effectiveness of stenting as a treatment for symptomatic single-vessel coronary disease : Use of a decision-analytic model. In: Circulation. 1994 ; Vol. 89, No. 4. pp. 1859-1874.
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