TY - JOUR A1 - Bonaventura, Klaus A1 - Leber, Alexander W. A1 - Sohns, Christian A1 - Roser, Mattias A1 - Boldt, Leif-Hendrik A1 - Kleber, Franz X. A1 - Haverkamp, Wilhelm A1 - Dorenkamp, Marc T1 - 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 JF - Clinical research in cardiology : official journal of the German Cardiac Society. N2 - 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. 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. In the base-case analysis, initial procedure costs amounted to a,not sign3,604.14 for DCB angioplasty and to a,not sign3,309.66 for DES implantation. Over a 12-month time horizon, the DCB strategy was found to be less costly (a,not sign4,130.38 vs. a,not sign5,305.30) 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. 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. KW - Cost-effectiveness KW - Drug-coated balloon KW - Drug-eluting stent KW - Restenosis KW - Revascularization Y1 - 2012 U6 - https://doi.org/10.1007/s00392-012-0428-2 SN - 1861-0684 VL - 101 IS - 7 SP - 573 EP - 584 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Dorenkamp, Marc A1 - Bonaventura, Klaus A1 - Leber, Alexander W. A1 - Boldt, Julia A1 - Sohns, Christian A1 - Boldt, Leif-Hendrik A1 - Haverkamp, Wilhelm A1 - Frei, Ulrich A1 - Roser, Mattias T1 - Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension JF - European heart journal N2 - Aims Recent studies have demonstrated the safety and efficacy of catheter-based renal sympathetic denervation (RDN) for the treatment of resistant hypertension. We aimed to determine the cost-effectiveness of this approach separately for men and women of different ages. Methods and results A Markov state-transition model accounting for costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness was developed to compare RDN with best medical therapy (BMT) in patients with resistant hypertension. The model ran from age 30 to 100 years or death, with a cycle length of 1 year. The efficacy of RDN was modelled as a reduction in the risk of hypertension-related disease events and death. Analyses were conducted from a payer's perspective. Costs and QALYs were discounted at 3% annually. Both deterministic and probabilistic sensitivity analyses were performed. When compared with BMT, RDN gained 0.98 QALYs in men and 0.88 QALYs in women 60 years of age at an additional cost of (sic)2589 and (sic)2044, respectively. As the incremental cost-effectiveness ratios increased with patient age, RDN consistently yielded more QALYs at lower costs in lower age groups. Considering a willingness-to-pay threshold of (sic)35 000/QALY, there was a 95% probability that RDN would remain cost-effective up to an age of 78 and 76 years in men and women, respectively. Cost-effectiveness was influenced mostly by the magnitude of effect of RDN on systolic blood pressure, the rate of RDN non-responders, and the procedure costs of RDN. Conclusion Renal sympathetic denervation is a cost-effective intervention for patients with resistant hypertension. Earlier treatment produces better cost-effectiveness ratios. KW - Cost-effectiveness KW - Resistant hypertension KW - Renal sympathetic denervation KW - Prevention KW - Cardiovascular disease Y1 - 2013 U6 - https://doi.org/10.1093/eurheartj/ehs355 SN - 0195-668X VL - 34 IS - 6 SP - 451 EP - + PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Dorenkamp, Marc A1 - Boldt, Julia A1 - Leber, Alexander W. A1 - Sohns, Christian A1 - Roser, Mattias A1 - Boldt, Leif-Hendrik A1 - Haverkamp, Wilhelm A1 - Bonaventura, Klaus T1 - Cost-effectiveness of paclitaxel-coated balloon angioplasty in patients with drug-eluting stent restenosis JF - Clinical cardiology : international journal for cardiovascular diseases N2 - BackgroundThe economic impact of drug-eluting stent (DES) in-stent restenosis (ISR) is substantial, highlighting the need for cost-effective treatment strategies. HypothesisCompared to plain old balloon angioplasty (POBA) or repeat DES implantation, drug-coated balloon (DCB) angioplasty is a cost-effective therapy for DES-ISR. MethodsA 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. ResultsInitial procedure costs amounted to Euro3488 for DCB angioplasty and to Euro2782 for POBA. Over a 6-month time horizon, the DCB strategy was less costly (Euro4028 vs Euro4169) and more effective in terms of life-years (LYs) gained (0.497 versus 0.489) than POBA. The DES strategy incurred initial costs of Euro3167 and resulted in 0.494 LYs gained, at total costs of Euro4101 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. ConclusionsDCB 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. Y1 - 2013 U6 - https://doi.org/10.1002/clc.22130 SN - 0160-9289 SN - 1932-8737 VL - 36 IS - 7 SP - 407 EP - 413 PB - Wiley-Blackwell CY - Hoboken ER -