Examining the economic impact of restenosis: implications for the cost-effectiveness of an antiproliferative stent.

Over the past decade, coronary stenting has been shown to reduce the rates of angiographic and clinical restenosis compared with conventional balloon angioplasty. Despite these improved outcomes, however, coronary stenting is still hampered by a high incidence of restenosis, with important clinical and economic consequences. Recently, the development of antiproliferative, drug-eluting stents has emerged as a promising solution for the primary prevention of restenosis. This paper summarizes the current evidence on the economic impact of coronary restenosis and explores the potential impact of introducing an antiproliferative stent on the cost-effectiveness of percutaneous coronary revascularization. A decision-analytic model based on current clinical and cost data is used to examine the potential cost-effectiveness of such stents. Although prospectively designed studies will be critical to define the true impact of drug-eluting stents on long-term survival, quality of life, and costs in a broad patient population our decision analytic model suggests that as long as these stents are reasonably priced, they may be cost saving for certain patients and cost-effective for virtually all patients undergoing PCI--at least within the U.S. healthcare system.