A projected cost analysis of endovascular treatments for peripheral vascular disease of the SFA.

Abstract

Purpose: Peripheral arterial disease (PAD) carries a significant disease burden, affecting 15% of the Australian population[1]. While percutaneous transluminal angioplasty (PTA) and bare metal stenting (BMS) have been mainstay treatments there is increasing evidence for the use of drug coated balloons (DCB) and drug eluting stents (DES) to improve the longevity of endovascular treatment[2, 3]. Our aim was to estimate the cost effectiveness of these interventions when adjusted for clinically driven target lesion revascularisation rates in an Australian hospital setting. Method(s): A systematic review was undertaken of level 1b (randomised control trials) data and re-intervention rates were extracted or extrapolated. Re-intervention rates were taken to be the weighted mean across published studies identified by systematic review. The mean device cost of DCB and DES were $AU1000 and $AU1775 respectively; cost projections to 24 months were calculated for PTA, BMS, DCB and DES therapies. Previously published hospital costing data[4] from FY 2013-2015 was utilised as a baseline for extrapolation. Result(s): The mean cost of admission for PTA and PTA with BMS was $8107 and $13966 respectively. The projected admission costs for DCB and DES were $9107 and $15741 respectively. When adjusted for 2 years of follow up and pooled re-intervention rates, the mean projected 2 year costs were $12,677 for PTA, $19,317 for BMS, $11,676 for DCBs, and $18,020 for DES. Conclusion(s): Our results suggest that in an Australian climate DCBs offer a lower 2 year re-intervention rate without extra cost; and both BMS & DES are less cost effective interventions.