title: Cost-effectiveness analysis of infrapopliteal drug-eluting stents.
abstract: BACKGROUND
  There are no cost-utility data about below-the-knee placement of drug-eluting stents. The authors determined the cost-effectiveness of infrapopliteal drug-eluting stents for critical limb ischemia (CLI) treatment.
  
  
  METHODS
  The event-free individual survival outcomes defined by the absence of any major events, including death, major amputation, and target limb repeat procedures, were reconstructed on the basis of two published infrapopliteal series. The first included spot Bail-out use of Sirolimus-eluting stents versus bare metal stents after suboptimal balloon angioplasty (Bail-out SES).The second was full-lesion Primary Everolimus-eluting stenting versus plain balloon angioplasty and bail-out bare metal stenting as necessary (primary EES). The number-needed-to-treat (NNT) to avoid one major event and incremental cost-effectiveness ratios (ICERs) were calculated for a 3-year postprocedural period for both strategies.
  
  
  RESULTS
  Overall event-free survival was significantly improved in both strategies (hazard ratio (HR) [confidence interval (CI)]: 0.68 [0.41-1.12] in Bail-out SES and HR [CI]: 0.53 [0.29-0.99] in Primary EES). Event-free survival gain per patient was 0.89 (range, 0.11-3.0) years in Bail-out SES with an NNT of 4.6 (CI: 2.5-25.6) and a corresponding ICER of 6,518<euro> (range 1,685-10,112<euro>). Survival gain was 0.91 (range 0.25-3.0) years in Primary EES with an NNT of 2.7 (CI: 1.7-5.8) and an ICER of 11,581<euro> (range, 4,945-21,428<euro>) per event-free life-year gained. Two-way sensitivity analysis showed that stented lesion length >10 cm and/or DES list price >1000<euro> were associated with the least economically favorable scenario in both strategies.
  
  
  CONCLUSIONS
  Both strategies of bail-out SES and primary EES placement in the infrapopliteal arteries for CLI treatment exhibit single-digit NNT and relatively low corresponding ICERs.
authors.affiliation: Department of Interventional Radiology, School of Medicine, Patras University Hospital, 26504, Rion, Greece. katsanos@med.upatras.gr
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Katsanos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Karnabatidis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Diamantopoulos
authors.forename: Stavros
authors.initials: S
authors.lastname: Spiliopoulos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Siablis
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000191:economics* / Q000706:statistics & numerical data; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D008670:Metals; D000068338:Everolimus; D020123:Sirolimus