Cohen, D.J.

Koens, B.A.H.

Serruys, P.W.

van Hout, B.A.

Elsevier - Publisher Connector 

Costs and effects of stent implantation versus balloon angioplasty 

I 1027 Cost-Effectiveness of lntracoronery SIents 
Sunday, March 29, 1988, 5:00 p.m.-7:OO p.m. 
Georgia World Congress Center, West Exhibit Hall Level 
Presentation Hour: 5:00 p.m.-7:OO p.m, 
Cardiac lntervantlonal Procedurea Performed In 
Europo During a Four Year Obaervatlon Farlod 
From 1992 to 1996 
t3&goimd: An nnnunl aurvay an paraulnnaaua finrdinc Inlanonllona hoe 
bean fianduolad by Iha Eurapann Baclely al Cordlalagy alnca 1802. Tha 
purpose al thla aludy WRR la nnnlyxa Iha lrands In onrdlnc inlarvanllans 
during thl@ abaarvnllan perlad. 
MathadtiRear~fts: A quaflllannlra WRR dlslnbulad Ihmugh Iha nnllannl 
aaclatlaa al cnrdlalagy la 35 mambar nlalaa al lho Europann Sac~nly al 
Cnrdlalagy. Thn quaallannnlm conlnlnn n dotnllcd Ilsllng al 011 parculonaaua 
cnrdlna Intarvanllane. The ramills al this aufvay nm Rummnrlrad m the Inbla 
balaw: 
Cona/tc.slans: 1. Tha numbor 01 camnoly nngla@rnms Incransas RI nn 
nnnunl mla al 1% 2. Tha numbar of PTCA’a lncransas RI on nnnual rnla 
ol 2tXbh. 3, Camnnry slanllng IA lha fnslael grawlng pmcadum In intorvan, 
tlannl cnrdlalogy. 4. PTCA conllnuan lo aurpnaa CA8Q ns ravnsoulnnmt1on 
amcaduro. 
[ji=] Appllcatlon of Crltlcal Pathways In the 
lntroductlon of Now Medlcal Tachnoloav: The 
lntracoronary Stent as a Model -* 
H.D. Aranaw. K.A. Engla. E.R. Betas, S.W. Warns. O.W.M. Mullor. 
E. Kllna-Ragars. O.J. Knrnvlto. P.L Ruvsmnn, M. Moscucct. The Unrvors~fy 
of Mchtqan. Ann A&or, MI. US4 
Alto, the lnilml rovonrch bmnklhrough. now modlcnl technology can be further 
dovalopod, Improved. nnd ndnplod lo now mdlcnttons. By slnnderdtirmg end 
opt!mlrlnfl lhacnm pmcoss. crmcnl pnlhwnys (CP) may lnc1klolo lho inlroduc- 
lion ol new modlcnl technology and Iha rapld 1mplomonlnllon 01 changes In 
anctllnry core. Tho davalopmont ol mtracoronnly slonlmg. wvlth tho Qvolullon 
In pamprocadurnl cnm nnd nnhcongulallon mglmon. IS i\ usotul pnradlgm. 
Wo mpon our oxpononco wllh tntrncoronnly stonlmg fls Q modal for CP ap- 
plicnllan. Bahvaon 8.Y&93 nnd 3/31/97,494 consocullve pnllanls undorwont 
inlncamnafy slonllng far stnblo or unstable coronary syndromes during 4 
phases of CP ovolullon (Podods A lhrougb 0). Ouring lhat hme. lighter blood 
pmssum cantrol wns implamentod. shoalh mmovQl prncticos were mvlsed 
nnd Ihe pod-pmcodural antlcongulnt1an rqlmon was pro9rassivoly Ilbernl. 
Irod from ono that Included doxlmn. IV hopnrin. wnriarin 01 II target INR of 
3-4. dipyndflmolo end ASA (A). to a ImQI mglmon that contamed nellher 
post*pmcedum hopadn nor wadann (02). As lroalmonl algorithms evolved. 
vascular complication ram (VC). blood trQnslus!on rate (Txl) and post-pro- 
cQdura Ionglh-ol-slay (LOS) decreased sigmlicantly wilhout a consequent 
lncreasa in lho rate of subacute stenl lhrombosls (SST). 
Ponod m) AKW B (9~ c 118) D1 (1.X) D2(291) P 
TX1 (“0) 400 22 2 167 15: ‘1.1 0.001 
vc (“01 167 0 56 55 27 0 008 
LOS dSysl 9D! 7: 5s ! OR 36115 5 5 ! G.3 22 i 39 ,OOOl 
SST (“4 0 0 0 14 Oi 0869 
The observed reduclion m compkcallon rates and LOS was likely the 
result of changes In anhcoagulatlon regimen. The CP proved instrumental 
In fac~lilstlnfl the raptd and Controlled mtroduclian of chanflss in the care 
process and In lrackmg the effects of those changes on clinical outcomes. 
1027-49 Cost of Clinical Restenosis and 
Cost-effectiveness of Therapy to Prevent it 
W.S. Weintraub. Emory Umversify, Aflanta. GA. USA 
Restonos!s. a major llmilat~on of PTCA. tncroases cost by addtng resource 
use, aspoci~ily rfipanl procedures, Roconlly rastanosls hAA boon dofmod 
cllnlcelly, nnd for this study wns dOflnQd ns dcalh, myacrtrdlal Infarclian. 
nddlllanal PTCA or CABG oftor succosslul, uni-~mpllcnled therapy. Chnrgos 
for nddlllonnl hospllnllrallans wore dolarmlned fram the UB92 farms, Qnd 
reduced to cosl by dopndmanlnl cost lo charge rnlla. cast nra oxpressed 
1996 dollnm. 8alwoen 1999 nnd 1995 lham worn 5,795 pnlianls suilnblo 
for ahidy wllh cost dnln nvallnblo. Tho cord al cllnlcr(l rsstenosls (n P 1,131 
ar 19.5?‘.) was $9,833 (25?dl a 78% mngo $7,483 IO Sii,ais). Thare wss 
limllad ablllty to pradlct cllnlcrM ro~lsnaflla (aran rmdar ROC cu~vt) O,aO) nnd 
avan taas ta pradtct Ihr caRI (r2 a 3.05). Thus R sullgbla preventive lhempy 
will prabflbly ba usad In all paaaibb pnlianls, II lho alfqchvsnass al prQvonliv@ 
lharapy Itr 50% and thn coal nl lhsrnpy $2,600, II will cast $18,OOIl par Qvsnl 
pmvanlad: II cast al lhornpy I8 fil,OOO, casl per avant pravontod falls to 
$833. 
02 ’ ’ 
.I 
i%eollvOeanosa 
0’0 lh 
Tha ligum 1s a two wny aonslltvily nnalysm 01 ofIecttvonoss 01 prevcmhve 
lhornpy lram 10% la lCO% and onch lina tmm bottom la lop. 19 @n csobar 01 
cost ham $500 to $5000 in $500 slaps. Cost affocl~vanc5s (C-E) Impraves 
wilh lawar cost ol lhompy nnd improved offcclnronose Rcslonosis 1s llkoly IO 
mmnm n pmblom nltor PTCA until inoxpons~vo. hj9hly ol?ccl~ prevonhvc 
thompy 18 avntlnbto. 
Cost affcctcvanoss nnalysts may holp fluid0 Iho chotce of therapy and tn 
volling poltcy over use al scarce nxources 
1027-50 Costs and Effects of Stent lmplantatlon Versus 
Balloon Angloplasty 
B A. van Haul , O.J. Cohen’. B.A.H. Keens-‘. P.W. Sorruys’. ‘brshrufe for 
Medrcal Technology Assessment Emsrnus Umversrl): Rotterdam. 
Nefhedands: JfJufch Cenfre for Heatfh Economics and System Scrence. 
Rotterdam. Nether/and.% JThomxcenfre Academs bkxp~tal. Rofterdam. 
Nclherlands: -‘Beth fsrael Hosplfal. Bosfon &lA. USA 
Background. The Bonoslenl II study IS destgned nol only to assess salely and 
offlcacy al lhe hopann coaled Palmar-Schalr stenl but also lo mvesltgate 
tho bakmce between the costs nnd effects. 
Methods: Cost QffecI~venoss ISQsllmated al one year alter randamlzahon 
Olmct medlcal costs am calculated by multlplymg detalled resourca ubkzalion 
data with US cost estimates. EIfects are expressed m lens 01 event free 
survival includmfl doath. MI. slroko and all rc-mteluentlons as events. Cost 
effectiveness IS expressed m terms 01 incremental cost effectiveness rabo’s. 
Subgroup analysQs concDm LAO. vessel szo .3 mm and stable/unstable 
Qngina 
Resulfs: Event lrec sutv~val IS esbmated at 88.8% alter stonl lmplantahon 
and al 79.096 alter PTCA. The addlhonal costs per addltlonal event lree 
survivor are esbmaled al $14.473 (95”o Cl: S- 1.523-594.073). Subgroup 
analysis shows more favorable results for stenl tmplantal1on m LAD lessons. 
In lesions with vessal size .3 mm. and In pabents wllh unstable angma. Cost 
savings are expected for pakents with a lesion m the LAO and a vessel size 
.3 mm ($11.481 for stent Implantalton versus 514.558 for PTCA). Here. the 
upper 95% km11 of the mcremcnlal cost effeclweness ratio IS estimated al 
$3.119. 
Conclusion: A strategy of slenl lmplanlation in all pabents is more effective 
but also more costly than a strategy starling wilh PTCA (and a stnct definillon 
of bail out stentmg). Appropriate patient selecbon (LAO. vessel size .3 mm) 
however. may lead lo cost savmgs. 
1027-51 ] Clinical, Resource and Cost Benefits of the 
RESTORE Study Applied to US Population 
S.J. Boccuzzt. J.B. Roehm. JR. Cook, J.C. Durnette. S. Culler. 
W.S. Weintraub. Merck and Co. Inc.. Wesf Point PA: Emory University. 
Atlanta. GA. USA 
RESTORE, a randomized efficacy study of tirofiban for outcomes and r-- 
stenosis, evaluated the effectiveness. resource utikzatlon and cost of llblllla 


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Costs and effects of stent implantation versus balloon angioplasty

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