title: In-hospital outcomes and cost comparison of femoropopliteal reopening strategies.
abstract: OBJECTIVE
  Atherectomy has emerged as an alternative to percutaneous transluminal angioplasty (PTA) for endovascular reopening. Despite increasing use of atherectomy (and higher cost of atherectomy catheters compared with balloon catheters), few studies have compared outcomes and costs with other reopening strategies.
  
  
  METHODS
  We performed a retrospective cohort study involving all patients undergoing isolated femoropopliteal PTA (n=69) or atherectomy (n=92) at our institution from 1/2005 to 4/2006. The choice of reopening strategy was left to the treating physician, and no patients with relative contraindications to stent placement (specifically common femoral artery lesions) were included. Device and supply costs were calculated using the hospital resource-based accounting system, and other costs were calculated using the hospital micro-cost accounting system. Professional fees were calculated from the Medicare Fee Schedule.
  
  
  RESULTS
  Baseline characteristics were generally well matched. There were no significant differences in complications (vascular complications, urgent repeat reopening, death, myocardial infarction, or stroke) between groups (PTA 8.7% vs. atherectomy 5.4%, P=.53). PTA required more balloons (2.0±0.8 vs. 0.7±1.0, P<.001) and stents (1.5±0.8 vs. 0.2±0.5, P<.001), but fewer atherectomy catheters (0.0±0.0 vs. 1.2±0.4, P<.001). Neither procedural supply costs (PTA $3137±1459 vs. atherectomy $3338±1505, P=.20) nor total costs differed between PTA and atherectomy patients ($10,945±4521 vs. $10,783±3857, P=.42).
  
  
  CONCLUSIONS
  Initial outcomes and costs are comparable for femoropopliteal PTA and atherectomy. The choice of reopening strategy should therefore be based on operator experience and anatomic suitability. Further studies are required to determine whether there are differences in long-term outcomes or costs between these approaches.
authors.affiliation: Saint-Luke's Mid America Heart Institute, St. Luke's Hospital, Kansas City, MO 64111, USA. dsafley@cc-pc.com
authors.forename: David M
authors.initials: DM
authors.lastname: Safley
authors.forename: Jason B
authors.initials: JB
authors.lastname: Lindsey
authors.forename: Katherine
authors.initials: K
authors.lastname: Robertus
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mahoney
authors.forename: Keith B
authors.initials: KB
authors.lastname: Allen
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D017073:Atherectomy / Q000009:adverse effects / Q000191:economics*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D005260:Female; D005263:Femoral Artery; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D018803:Models, Economic; D018579:Patient Selection; D011150:Popliteal Artery; D015607:Stents / Q000191:economics; D016896:Treatment Outcome