BACKGROUND: Percutaneous coronary intervention (PCI) with coronary stenting is a common medical procedure that is used to treat the symptoms of both stable angina and acute coronary syndromes. Drugeluting stents (DES) decrease restenosis and repeat revascularization procedures but are more expensive than bare-metal stents. A proper cost-effectiveness analysis of DES requires an understanding of the health value patients place on the avoidance of restenosis accompanied by a repeat PCI. OBJECTIVE: To estimate quality-of-life (QoL) benefits ascribed to avoiding the return of coronary symptoms and the need for a repeat revascularization procedure. METHODS: A prospective, single-centre study was conducted involving PCI patients. A time trade-off (TTO) question, based on a hypothetical restricted lifespan of 10 years, was used to estimate the QoL benefits patients attach to the avoidance of recurrent symptoms and a repeat PCI. This was accomplished by interviewing the patients by telephone, two weeks post-PCI. The TTO question was also administered to the catheterization laboratory staff. RESULTS: Between January and March 2007, and between April and June 2008, 103 interviews were completed. The median TTO was zero weeks (interquartile range zero to 1.7 weeks). Six interventional cardiologists and eight cardiac catheterization nurses reported a similar median disutility. CONCLUSION: Despite acknowledgement of the substantial clinical benefits of DES, the results of the present study suggest that patients do not place a great disutility on avoiding restenosis, thereby providing little QoL justification for the large incremental cost associated with this technology.
BACKGROUND: Percutaneous coronary intervention (PCI) with coronary stenting is a common medical procedure that is used to treat the symptoms of both stable angina and acute coronary syndromes. Drugeluting stents (DES) decrease restenosis and repeat revascularization procedures but are more expensive than bare-metal stents. A proper cost-effectiveness analysis of DES requires an understanding of the health value patients place on the avoidance of restenosis accompanied by a repeat PCI. OBJECTIVE: To estimate quality-of-life (QoL) benefits ascribed to avoiding the return of coronary symptoms and the need for a repeat revascularization procedure. METHODS: A prospective, single-centre study was conducted involving PCI patients. A time trade-off (TTO) question, based on a hypothetical restricted lifespan of 10 years, was used to estimate the QoL benefits patients attach to the avoidance of recurrent symptoms and a repeat PCI. This was accomplished by interviewing the patients by telephone, two weeks post-PCI. The TTO question was also administered to the catheterization laboratory staff. RESULTS: Between January and March 2007, and between April and June 2008, 103 interviews were completed. The median TTO was zero weeks (interquartile range zero to 1.7 weeks). Six interventional cardiologists and eight cardiac catheterization nurses reported a similar median disutility. CONCLUSION: Despite acknowledgement of the substantial clinical benefits of DES, the results of the present study suggest that patients do not place a great disutility on avoiding restenosis, thereby providing little QoL justification for the large incremental cost associated with this technology.
Authors: Eugène P McFadden; Eugenio Stabile; Evelyn Regar; Edouard Cheneau; Andrew T L Ong; Timothy Kinnaird; William O Suddath; Neil J Weissman; Rebecca Torguson; Kenneth M Kent; August D Pichard; Lowell F Satler; Ron Waksman; Patrick W Serruys Journal: Lancet Date: 2004 Oct 23-29 Impact factor: 79.321
Authors: Pekka Kuukasjärvi; Pirjo Räsänen; Antti Malmivaara; Pasi Aronen; Harri Sintonen Journal: Int J Technol Assess Health Care Date: 2007 Impact factor: 2.188
Authors: Mohan N Babapulle; Lawrence Joseph; Patrick Bélisle; James M Brophy; Mark J Eisenberg Journal: Lancet Date: 2004 Aug 14-20 Impact factor: 79.321
Authors: Erick Schampaert; Eric A Cohen; Michael Schlüter; François Reeves; Mouhieddin Traboulsi; Lawrence M Title; Richard E Kuntz; Jeffrey J Popma Journal: J Am Coll Cardiol Date: 2004-03-17 Impact factor: 24.094