Published Online
on June 24, 2002

A more recent version of this article appeared on August 6, 2002

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Submitted on April 8, 2002
Revised on May 9, 2002
Accepted on May 9, 2002

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, and 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.).

^* To whom correspondence should be addressed. 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

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