title: Percutaneous stenting of incidental unilateral renal artery stenosis: decision analysis of costs and benefits.
abstract: OBJECTIVE
  To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S).
  
  
  METHODS
  The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death.
  
  
  RESULTS
  Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year.
  
  
  CONCLUSIONS
  PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.
authors.affiliation: Departments of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 498109-0604, USA. devaxe@umich.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Axelrod
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Carlos
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Alan B
authors.initials: AB
authors.lastname: Weder
authors.forename: Paul H
authors.initials: PH
authors.lastname: Abrahamse
authors.forename: James C
authors.initials: JC
authors.lastname: Stanley
mesh_terms: D000800:Angioplasty, Balloon; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D033162:Incidental Findings; D008390:Markov Chains; D012078:Renal Artery Obstruction / Q000191:economics* / Q000628:therapy*; D015607:Stents / Q000191:economics*