Korean Circulation Journal

  • 제41권12호
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  • Pages.705-711
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  • 2011
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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Analysis of Potential Cost-Savings After Introduction of Drug-Eluting Balloon Angioplasty for In-Stent Restenosis or Small Vessel Disease

  • Park, Kyung-Il (Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Tae-Eun (Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Park, Kyung-Woo (Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kang, Hyun-Jae (Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Koo, Bon-Kwon (Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Hyo-Soo (Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine)
  • 발행 : 2011.12.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: The drug-eluting balloon (DEB) catheter system was developed to treat restenosis. Furthermore, DEB angioplasty has been shown to reduce restenosis risk when compared to drug-eluting stents (DES) in patients with in-stent restenosis (ISR) or small vessel disease (SVD). In addition, DEB angioplasty reduces costs due to fewer revascularizations and reduced clopidogrel treatment length. The objective of this study was to predict the expected cost-savings when DEB is substituted for DES in patients with ISR or SVD. Subjects and Methods: The subjects included were patients treated by DES at Seoul National University Hospital from January 2006 to June 2009, with clinical data after percutaneous coronary intervention, were. A model was developed to allow the costs of DES and the calculated costs of DEB incurred by patients with ISR or SVD to be compared. The overall cost of DEB was calculated to be 1,256,150 won and the overall cost of DES was 2,102,500 won, and the cost of clopidogrel was 2,168 won. Expected repeat revascularizations within 12 months of DEB were calculated based on information provided by the Paclitaxel-Eluting PTCA-Balloon Catheter in Coronary Artery (PEPCAD) I and II trials. Results: By substituting DEB for DES, total cost (including the cost of initial DEB treatment, the cost of repeat revascularization after DEB treatment, and the cost of clopidogrel treatment) was found to be 34% lower in ISR patients and 48% lower in SVD patients. Conclusion: DEB angioplasty will significantly reduce costs as compared to DES in ISR and in SVD patients.

키워드

참고문헌

  1. Stone GW, Ellis SG, Cannon L, et al. Comparison of a polymer-based paclitaxel-eluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial. JAMA 2005;294:1215-23. https://doi.org/10.1001/jama.294.10.1215
  2. Iofina E, Haager PK, Radke PW, et al. Sirolimus- and paclitaxel-eluting stents in comparison with balloon angioplasty for treatment of instent restenosis. Catheter Cardiovasc Interv 2005;64:28-34. https://doi.org/10.1002/ccd.20212
  3. Kastrati A, Mehilli J, von Beckerath N, et al. Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. JAMA 2005;293:165-71. https://doi.org/10.1001/jama.293.2.165
  4. Virmani R, Guagliumi G, Farb A, et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation 2004;109:701-5. https://doi.org/10.1161/01.CIR.0000116202.41966.D4
  5. Posa A, Hemetsberger R, Petnehazy O, et al. Attainment of local drug delivery with paclitaxel-eluting balloon in porcine coronary arteries. Coron Artery Dis 2008;19:243-7. https://doi.org/10.1097/MCA.0b013e3283030b26
  6. Cremers B, Speck U, Kaufels N, et al. Drug-eluting balloon: very short-term exposure and overlapping. Thromb Haemost 2009;101:201-6.
  7. Unverdorben M, Vallbracht C, Cremers B, et al. Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis. Circulation 2009;119:2986-94. https://doi.org/10.1161/CIRCULATIONAHA.108.839282
  8. Hong SJ, Ahn TH, Kim MH, et al. Comparison of the predictors of cronary restenosis after drug-eluting stent implantation in diabetic and nondiabetic patients. Korean Circ J 2007;37:530-7. https://doi.org/10.4070/kcj.2007.37.11.530
  9. Elezi S, Kastrati A, Neumann FJ, Hadamitzky M, Dirschinger J, Schomig A. Vessel size and long-term outcome after coronary stent placement. Circulation 1998;98:1875-80. https://doi.org/10.1161/01.CIR.98.18.1875
  10. Unverdorben M, Kleber FX, Heuer H, et al. Treatment of small coronary arteries with a paclitaxel-coated balloon catheter. Clin Res Cardiol 2010;99:165-74. https://doi.org/10.1007/s00392-009-0101-6
  11. Scheller B, Hehrlein C, Bocksch W, et al. Two year follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter. Clin Res Cardiol 2008;97:773-81. https://doi.org/10.1007/s00392-008-0682-5
  12. Bauters C, Hubert E, Prat A, et al. Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol 1998;31:1291-8. https://doi.org/10.1016/S0735-1097(98)00076-X
  13. Novack V, Nguyen MC, Rooney M, et al. Effect of coronary target lesion revascularization on late cardiac events after insertion of sirolimus-eluting or bare metal stents. Am J Cardiol 2010;106:774-9. https://doi.org/10.1016/j.amjcard.2010.04.039
  14. Scheller B, Speck U, Abramjuk C, Bernhardt U, Bohm M, Nickenig G. Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis. Circulation 2004;110:810-4. https://doi.org/10.1161/01.CIR.0000138929.71660.E0
  15. Scheller B, Speck U, Romeike B, et al. Contrast media as carriers for local drug delivery: successful inhibition of neointimal proliferation in the porcine coronary stent model. Eur Heart J 2003;24:1462-7. https://doi.org/10.1016/S0195-668X(03)00317-8
  16. Scheller B, Hehrlein C, Bocksch W, et al. Treatment of coronary instent restenosis with a paclitaxel-coated balloon catheter. N Engl J Med 2006;355:2113-24. https://doi.org/10.1056/NEJMoa061254
  17. Lee CW, Park SJ. Predictive factors for restenosis after drug-eluting stent implantation. Korean Circ J 2007;37:97-102. https://doi.org/10.4070/kcj.2007.37.3.97
  18. Kuntz RE, Safian RD, Carrozza JP, Fishman RF, Mansour M, Baim DS. The importance of acute luminal diameter in determining restenosis after coronary atherectomy or stenting. Circulation 1992;86:1827-35. https://doi.org/10.1161/01.CIR.86.6.1827
  19. Savage MP, Fischman DL, Rake R, et al. Efficacy of coronary stenting versus balloon angioplasty in small coronary arteries: Stent Restenosis Study (STRESS) Investigators. J Am Coll Cardiol 1998;31:307-11. https://doi.org/10.1016/S0735-1097(98)81982-7
  20. Ardissino D, Cavallini C, Bramucci E, et al. Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial. JAMA 2004;292:2727-34. https://doi.org/10.1001/jama.292.22.2727
  21. Whang YJ, Kim HS, Kim KM, et al. The efficacy of drug eluting stents on restenosis reduction in small coronary arteries. Korean Circ J 2006;36:450-7.
  22. Cortese B, Micheli A, Picchi A, Coppolaro A, et al. Paclitaxel-coated balloon versus drug-eluting stent during PCI of small coronary vessels, a prospective randomised clinical trial: the PICCOLETO Study. Heart 2010;96:1291-6. https://doi.org/10.1136/hrt.2010.195057

피인용 문헌

  1. Cost-Effectiveness of Paclitaxel-Coated Balloon Angioplasty in Patients With Drug-Eluting Stent Restenosis : Cost-effectiveness of DCB angioplasty vol.36, pp.7, 2013, https://doi.org/10.1002/clc.22130