Restenosis: the cost to society.

Restenosis occurs in 20% to 55% of arteries subjected to percutaneous intervention procedures and is an important cause of recurrent symptomatic angina. More than half of the patients in whom angiographically defined restenosis develops will require an additional revascularization procedure within 6 months, and as many as 80% of patients with angiographically defined restenosis will need to undergo repeat revascularization within 6 years. It has been calculated that a treatment that would reduce the risk of restenosis by 25% would save $1400 per patient in hospital, procedural, and professional fees, and a 33% risk reduction would save $2000 per patient. An economic analysis of the Evaluation of 7E3 for the Prevention of Ischemic Complications (EPIC) trial results has demonstrated that the 26% reduction in the 6-month rate of restenosis achieved with c7E3 treatment translated into a saving per patient of more than $1000 in medical costs, not counting the cost of the drug, which reflects a reduced incidence of rehospitalization and substantial declines in the need for repeat angioplasty and bypass surgery. Although few other therapies have been subjected to a prospective cost analysis in several thousand patients, future and past therapies should be initially evaluated with use of the same methods. According to an economic analysis of a small sample of patients in the Stent Restenosis Study (STRESS) trial, similar cost savings may be achieved by stent implantation.