Economic Analysis Compares Endovascular Interventions in Femoropopliteal PAD Treatment

November 3, 2015—An evaluation of the 3-year economic impact of five endovascular strategies for the treatment of femoropopliteal peripheral artery disease (PAD) was presented by Brian DeRubertis, MD, during the second of two Late-Breaking Trials sessions at VIVA 15, the 13th annual Vascular InterVentional Advances meeting. The meeting, which is sponsored by VIVA Physicians, Inc., is being held November 2–5, 2015, at the Wynn Las Vegas in Las Vegas, Nevada. The session moderators are Michael R. Jaff, DO, and Krishna Rocha-Singh, MD.

The study compared percutaneous transluminal angioplasty (PTA), bare-metal stents (BMSs), drug-eluting stents (DESs), drug-coated balloons (DCBs), and the Supera interwoven nitinol stent (Abbott Vascular) from the perspectives of the United States payer (Medicare) and hospitals.

As summarized at VIVA, rates of target lesion revascularization (TLR) observed in United States investigational device exemption studies were identified for PTA, BMS, DES, DCB, and interwoven nitinol stent procedures. A decision-analytic model was developed to estimate the costs associated with each strategy. Risk of TLR was used to derive the expected number of reinterventions for each strategy over 3 years.

The economic impact to payers was estimated as the per-patient cost for each strategy, which was determined by combining the projected number of TLRs with the corresponding procedural costs associated with each strategy. The economic impact to hospitals was assessed as the remaining payment, defined as the facility reimbursement from payers minus the device cost for each procedure.

The investigator concluded that the results of the economic analysis suggest that from the patient perspective, the interwoven nitinol stent was associated with the lowest risk of repeat procedures. From the payer perspective, the interwoven nitinol stent was more effective and provided cost savings compared to PTA, BMS, DES, and DCB. 

Dr. DeRubertis reported that from the hospital perspective, the interwoven nitinol stent resulted in the greatest remaining payment per procedure compared to PTA, BMS, DES, and DCB.