Economic analysis of endovascular interventions for femoropopliteal arterial disease: a systematic review and budget impact model for the United States and Germany.
OBJECTIVE
To study the economic impact on payers and providers of the four main endovascular strategies for the treatment of infrainguinal peripheral artery disease.


BACKGROUND
Bare metal stents (BMS), drug-eluting stents (DES), and drug-coated balloons (DCB) are associated with lower target lesion revascularization (TLR) probabilities than percutaneous transluminal angioplasty (PTA), but the economic impact is unknown.


METHODS
In December 2012, PubMed and Embase were systematically searched for studies with TLR as an endpoint. The 24-month probability of TLR for each treatment was weighted by sample size. A decision-analytic Markov model was used to assess the budget impact from payers' and facility-providers' perspectives of the four index procedure strategies (BMS, DES, DCB, and PTA). Base cases were developed for U.S. Medicare and the German statutory sickness fund perspectives using current 2013 reimbursement rates.


RESULTS
Thirteen studies with 2,406 subjects were included. The reported probability of TLR in the identified studies varied widely, particularly following treatment with PTA or BMS. The pooled 24-month probabilities were 14.3%, 19.3%, 28.1%, and 40.3% for DCB, DES, BMS, and PTA, respectively. The drug-eluting strategies had a lower projected budget impact over 24 months compared to BMS and PTA in both the U.S. Medicare (DCB: $10,214; DES: $12,904; uncoated balloons $13,114; BMS $13,802) and German public health care systems (DCB €3,619; DES €3,632; BMS €4,026; PTA €4,290).


CONCLUSIONS
DCB and DES, compared to BMS and PTA, are associated with lower probabilities of target lesion revascularization and cost savings for U.S. and German payers.
Wing Tech Inc., Menlo Park, California.
Jan B
JB
Pietzsch
Benjamin P
BP
Geisler
Abigail M
AM
Garner
Thomas
T
Zeller
Michael R
MR
Jaff
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D002017:Budgets; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000191:economics; D020099:Coated Materials, Biocompatible / Q000191:economics; D003251:Constriction, Pathologic; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics; D005263:Femoral Artery; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008390:Markov Chains; D006278:Medicare / Q000191:economics; D008670:Metals / Q000191:economics; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D011150:Popliteal Artery; D015607:Stents / Q000191:economics; D016896:Treatment Outcome; D014481:United States; D062666:Vascular Access Devices / Q000191:economics
D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; D008670:Metals
balloon; balloon angioplasty; drug coated/eluting; drug eluting; economics/cost-effectiveness; endovascular intervention; peripheral arterial disease; stent