Presentation (CTI)

OBJECTIVES: To compare the cost benefit, cost‑utility, and expected budget impact of drug‑coated balloons (DCB) versus drug‑eluting stents (DES) for patients with in‑stent restenosis (ISR) and small‑vessel disease (SVD) in Indonesia.
METHODS: A cost‑benefit analysis was conducted using a 1‑year decision tree model, and a cost‑utility analysis was performed using a 3‑year Markov model with monthly cycles. Target populations included patients with bare metal stent in-stent restenosis (BMS‑ISR) and drug eluting stent in-stent restenosis (DES‑ISR), aligned with Indonesian clinical practice. Inputs for clinical events, utilities, and transition probabilities were derived from published evidence, while direct medical costs reflected Indonesian data sources. Probabilistic sensitivity analyses (Monte Carlo, 1000 iterations) assessed uncertainty. All long‑term analyses applied a 3.5% discount rate, and half‑cycle correction was incorporated.
RESULTS: In ISR, DCB reduced annual costs by 11.1% (savings: Rp1,889,354.64 per patient/year). With an estimated 5,000 ISR cases annually, this equates to a national saving of ~Rp9 billion per year. In SVD, DCB yielded 23.7% cost savings (Rp4,148,714.68 per patient/year).
In the 3‑year cost‑utility analysis, DCB produced more QALYs at lower cost. For ISR, DCB generated 4.86 QALYs at Rp63.1M versus DES at 4.38 QALYs at Rp96.9M, resulting in an incremental gain of 0.48 QALYs and cost savings of Rp33.9M. Similar dominance was observed in SVD, where DCB gained an additional 0.13-0.14 QALYs while reducing costs by ~Rp124M. ICER scatter plots showed DCB consistently in the southeast quadrant, confirming dominance.
CONCLUSIONS: DCB is a cost‑saving and cost‑effective strategy compared with DES for both ISR and SVD in Indonesia. Findings support policy adoption and wider clinical use of DCB as a value‑optimized intervention within Indonesia’s health system.