This Article Full Text Full Text (PDF) All Versions of this Article: 106/6/691    most recent 01.CIR.0000023625.12626.29v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cohen, D. J. Search for Related Content PubMed PubMed Citation Articles by Cohen, D. J. Related Collections Health policy and outcome research Restenosis Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents

(Circulation. 2002;106:691.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Cost-Effectiveness of Gamma Radiation for Treatment of In-Stent Restenosis

Results From the Gamma-1 Trial

David J. Cohen, MD, MSc; Roberta S. Cosgrove, MS; Ronna H. Berezin, MPH; Paul S. Teirstein, MD; Martin B. Leon, MD; Richard E. Kuntz, MD, MSc, on behalf of the Gamma-1 Investigators

From Beth Israel Deaconess Medical Center, Boston, Mass (D.J.C.); Harvard Clinical Research Institute, Boston, Mass (R.S.C., R.H.B.); Scripps Clinic, La Jolla, Calif (P.S.T.); Lenox Hill Hospital, New York, NY (M.B.L.); and Brigham and Women’s Hospital, Boston, Mass (R.E.K.).

Correspondence to David J. Cohen, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. E-mail dcohen{at}caregroup.harvard.edu

Background— Recently, several randomized trials have demonstrated that intracoronary brachytherapy can reduce the rates of both angiographic and clinical restenosis in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis. Whether this practice is cost-effective is unknown.

Methods and Results— Between December 1997 and July 1998, 252 patients with in-stent restenosis were randomized to receive brachytherapy or placebo after successful PCI as part of the Gamma-1 trial. We collected detailed resource utilization and cost data for each patient’s initial hospitalization and for 1 year after randomization. Compared with conventional treatment, intracoronary brachytherapy increased procedure duration, physician services, and equipment costs. As a result, initial costs were increased by nearly $4100 per patient ($15 724 versus $11 675, P<0.001). Over the 1-year follow-up period, brachytherapy reduced the need for repeat revascularization by 21% and reduced the need for bypass surgery by 44%. Although follow-up medical care costs were $2200/patient lower with brachytherapy, total costs remained higher at 1 year ($28 543 versus $26 737, P=0.46). In a sensitivity analysis that incorporated recent technical modifications and the use of prolonged antiplatelet therapy to prevent late thrombotic occlusion, follow-up cost savings increased to $3600/patient, and 1-year costs were slightly lower with brachytherapy ($26 352 versus $26 729, P=0.87). Subgroup analysis demonstrated significant cost savings in patients with diabetes and patients who did not undergo repeat stenting.

Conclusions— As performed in the Gamma-1 trial, coronary brachytherapy for in-stent restenosis improved clinical outcomes but increased 1-year costs compared with standard therapy. If late thrombosis can be eliminated, however, this technology has the potential to reduce overall medical care costs.

Key Words: stents • restenosis • brachytherapy • cost-benefit analysis

This article has been cited by other articles:

				J. Ryan and D. J. Cohen Are Drug-Eluting Stents Cost-Effective?: It Depends on Whom You Ask Circulation, October 17, 2006; 114(16): 1736 - 1744. [Full Text] [PDF]

				S. Elezi, A. Dibra, U. Folkerts, J. Mehilli, S. Heigl, A. Schomig, and A. Kastrati Cost Analysis From Two Randomized Trials of Sirolimus-Eluting Stents Versus Paclitaxel-Eluting Stents in High-Risk Patients With Coronary Artery Disease J. Am. Coll. Cardiol., July 18, 2006; 48(2): 262 - 267. [Abstract] [Full Text] [PDF]

				A. Bakhai, G. W. Stone, E. Mahoney, T. A. Lavelle, C. Shi, R. H. Berezin, B. J. Lahue, M. A. Clark, M. J. Lacey, M. E. Russell, et al. Cost Effectiveness of Paclitaxel-Eluting Stents for Patients Undergoing Percutaneous Coronary Revascularization: Results From the TAXUS-IV Trial J. Am. Coll. Cardiol., July 18, 2006; 48(2): 253 - 261. [Abstract] [Full Text] [PDF]

				D. J. Cohen, A. Bakhai, C. Shi, L. Githiora, T. Lavelle, R. H. Berezin, M. B. Leon, J. W. Moses, J. P. Carrozza Jr, J. P. Zidar, et al. Cost-Effectiveness of Sirolimus-Eluting Stents for Treatment of Complex Coronary Stenoses: Results From the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) Trial Circulation, August 3, 2004; 110(5): 508 - 514. [Abstract] [Full Text] [PDF]

				D. Greenberg, A. Bakhai, and D. J. Cohen Can we afford to eliminate restenosis?: Can we afford not to? J. Am. Coll. Cardiol., February 18, 2004; 43(4): 513 - 518. [Abstract] [Full Text] [PDF]

				D. A. Cox, G. W. Stone, C. L. Grines, T. Stuckey, D. J. Cohen, J. E. Tcheng, E. Garcia, G. Guagliumi, R. S. Iwaoka, M. Fahy, et al. Outcomes of optimal or "stent-like"balloon angioplasty in acutemyocardial infarction: the CADILLAC trial J. Am. Coll. Cardiol., September 17, 2003; 42(6): 971 - 977. [Abstract] [Full Text] [PDF]

				R Seabra-Gomes In-stent restenosis: intracoronary {beta}-radiation at the crossroads Eur. Heart J., April 1, 2003; 24(7): 583 - 585. [Full Text] [PDF]

				D. E. Kandzari and D. B. Mark Intracoronary Brachytherapy: Time to Sell Short? Circulation, August 6, 2002; 106(6): 646 - 648. [Full Text] [PDF]