title: Cost-Effectiveness of Endovascular Femoropopliteal Intervention Using Drug-Coated Balloons Versus Standard Percutaneous Transluminal Angioplasty: Results From the IN.PACT SFA II Trial.
abstract: The aim of this study was to evaluate the cost-effectiveness of drug-coated balloon (DCB) angioplasty versus standard percutaneous transluminal angioplasty (PTA).
  
  
  
  Recent trials have reported lower rates of target lesion revascularization with DCB angioplasty versus standard PTA. However, the cost-effectiveness of DCB angioplasty is unknown.
  
  
  
  A prospective economic study was performed alongside the IN.PACT SFA II (IN.PACT Admiral Drug-Coated Balloon vs. Standard Balloon Angioplasty for the Treatment of Superficial Femoral Artery [SFA] and Proximal Popliteal Artery [PPA]) trial, which randomized 181 patients with femoropopliteal disease to the IN.PACT DCB versus standard PTA. Resource use data were collected over 2-year follow-up, and costs were assigned using resource-based accounting and billing data. Health utilities were assessed using the EuroQol 5-dimensions questionnaire. Cost-effectiveness was assessed as cost per quality-adjusted life-year (QALY) gained using a decision-analytic model on the basis of empirical data from the trial assuming identical long-term mortality.
  
  
  
  Initial costs were $1,129 per patient higher with DCB angioplasty than standard PTA, driven by higher costs for the DCB itself. Between discharge and 24 months, target limb-related costs were $1,212 per patient lower with DCB angioplasty such that discounted 2-year costs were similar for the 2 groups ($11,277 vs. $11,359, p = 0.97), whereas QALYs tended to be greater among patients treated with DCBs (1.53 ± 0.44 vs. 1.47 ± 0.42, p = 0.40). The probability that DCB angioplasty is cost-effective compared with standard PTA was 70% using a threshold of $50,000 per QALY gained and 79% at a threshold of $150,000 per QALY gained.
  
  
  
  For patients with femoropopliteal disease, DCB angioplasty is associated with better 2-year outcomes and similar target limb-related costs compared with standard PTA. Formal cost-effectiveness analysis on the basis of these results suggests that use of the DCB angioplasty is likely to be economically attractive.
authors.affiliation: Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Salisbury
authors.affiliation: Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Vilain
authors.affiliation: Mass General Vascular Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.affiliation: Division of Vascular Therapy, Department of Surgery, Kaiser Permanente, Honolulu, Hawaii.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Schneider
authors.affiliation: Division of Cardiovascular Medicine and Vascular Center, Department of Medicine, University of California, Davis, Sacramento, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
authors.affiliation: Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. Electronic address: dcohen@saint-lukes.org.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; 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; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D062666:Vascular Access Devices / Q000191:economics*
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
keywords: angioplasty; cost-effectiveness; drug-coated balloon; femoropopliteal artery; peripheral arterial disease