| Cost-effectiveness of gamma radiation for treatment of in-stent restenosis: results from the Gamma-1 trial. | |
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MedLine Citation:
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PMID: 12163429 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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David J Cohen; Roberta S Cosgrove; Ronna H Berezin; Paul S Teirstein; Martin B Leon; Richard E Kuntz; |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 106 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2002 Aug |
Date Detail:
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Created Date: 2002-08-06 Completed Date: 2002-08-22 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 691-7 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Mass 02215, USA. dcohen@caregroup.harvard.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary Brachytherapy / economics* Coronary Restenosis / economics*, etiology, radiotherapy* Coronary Thrombosis / economics, etiology Cost of Illness Cost-Benefit Analysis Double-Blind Method Female Gamma Rays / therapeutic use* Humans Male Middle Aged Stents / adverse effects* |
| Comments/Corrections | |
Comment In:
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Circulation. 2002 Aug 6;106(6):646-8
[PMID:
12163421
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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