Cost and patency rate targets for the development of endovascular devices to treat femoropopliteal arterial disease.
OBJECTIVE
To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease.


METHODS
A decision model was developed to compare treatment with the use of a hypothetical endovascular device with established therapies. Cost-effectiveness from the perspective of the health care system was considered. Outcome measures were lifetime costs and quality-adjusted life-years. With the use of net health benefit calculations and threshold analysis, combinations of costs and patency rates were determined that would make the device cost-effective compared with established therapies. In subgroup and sensitivity analyses, the effect on decision-making of sex, age, indication, lesion type, procedural risk, and society's willingness to pay for incremental gain in health were explored.


RESULTS
Use of a device that costs $3,000 would be cost-effective compared with bypass surgery for critical ischemia if the 5-year patency rate is 29%-46%. Use of the same device would be cost-effective compared with angioplasty for disabling claudication and stenosis if the 5-year patency rate is 69%-86%.


CONCLUSIONS
The target combinations of costs and patency rates found in this study are probably attainable, and further development of such endovascular devices seems warranted.
Muradin
G S
GS
Program for the Assessment of Radiological Technology (ART Program), Department of Radiology, Erasmus University Medical Center Rotterdam, Rm EE21-40a, Dr. Molewaterplein 50, 3015 GE Rotterdam, the Netherlands.
Myriam Hunink
M G
MG
D001157:Arterial Occlusive Diseases / Q000191:economics* / Q000628:therapy*; D001807:Blood Vessel Prosthesis / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D004867:Equipment Design; D005263:Femoral Artery; D006801:Humans; D011150:Popliteal Artery; D011474:Prosthesis Design; D015607:Stents / Q000191:economics*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures