Comparison of 3-Year United States Payer Costs for Endovascular Treatment Options to Treat Femoropopliteal Artery Disease.

PURPOSE: To assess costs and cost effectiveness of bare metal stent (BMS), drug-eluting stent (DES), and paclitaxel drug-coated balloon (DCB) relative to percutaneous transluminal angioplasty (PTA) for treatment of femoropopliteal peripheral artery disease (PAD) in the United States.

MATERIALS AND METHODS: An economic model was developed to assess the 3-year cost and cost effectiveness from a U.S. payer perspective of PTA, BMS, DES, and paclitaxel DCB. Model inputs were derived from the literature. Costs were obtained from 2023 U.S. Medicare national-mean rates and included hospital outpatient and physician reimbursement. The authors used Medicare national-mean rates to reflect costs to the Medicare system. Sensitivity analyses evaluated the impact of bailout stent and target lesion revascularization (TLR) rates on results.

RESULTS: The estimated mean per-person costs for endovascular procedures over 3 years were $9,151 for PTA, $13,325 for BMS, $13,054 for DES, and $8,406 for DCB. U.S. Food and Drug Administration (FDA)-approved DCBs showed comparable economic value, with costs between $8,027 and $8,804 for IN.PACT Admiral, Stellarex, Lutonix, and Ranger devices. Incremental quality-adjusted life years (QALYs) gained were between 0.0035 and 0.0054 for strategies compared with PTA. DCBs were cost-saving, whereas BMS and DES were not cost-effective with incremental cost-effectiveness ratios > $150,000/QALY gained. The sensitivity analysis results showed that PTA and DCB bailout stent rates had the largest impact on costs; however, DCBs remained cost-saving in most cases.

CONCLUSIONS: DCBs provided a moderate cost-savings in endovascular procedure costs over PTA due to lower TLR rates over 3 years. DES and BMS were not cost-effective from a U.S. payer perspective despite similar TLR rates as DCBs due to higher reimbursement levels and minimal gains in QALYs.