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Cost analysis shows mixed results for drug-eluting balloons
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Drug-eluting balloons cut Medicare costs but also reduced hospital/provider financial margins in a study presented at Vascular Interventional Advances.
The reason is because if drug-eluting balloons provide the lowest financial return for providers, “[Medicare providers] will tend not to use it and won’t be inclined to make it available to their patients. They will use technologies that give them a better result for their bottom line,” study investigator Michael R. Jaff, DO, with Massachusetts General Hospital, Boston, said in a press conference.
In the study, Jaff along with fellow researchers compared results from 12 studies published from 2006 to 2012 to determine the proportion of target lesion revascularization rates after index treatment with percutaneous transluminal angioplasty (PTA), bare-metal stents, drug-eluting stents or DEB.
Researchers then sought to develop a model to evaluate economic consequences of various index procedure strategies and estimate the economic impact of treatment with DEB on Medicare costs. They performed a pooled analysis that excluded results from two trials, SIROCCO (2006) and STRIDES (2011), since these DES studies were negative.
Follow-up at 24 months revealed the following results of freedom from TLR:
- DEB: 91.4% free from TLR at 12 months and 83.5% at 24 months;
- DES: 91.4% at 12 months and 83.5% at 24 months;
- BMS: 87.6% at 12 months and 76.8% at 24 months; and
- (Optimal) balloon angioplasty: 71.4% at 12 months to 51% at 24 months.
These results suggested potential noninferiority between BMS, DES and DEB, Jaff said.
Michael R. Jaff, DO
Estimated 24-month Medicare costs were lowest for DEB ($6,317), followed by PTA ($9,241), DES ($9,700) and BMS ($10,006). Provider margin was highest for BMS ($ 8,125), followed by PTA ($7,739), DES ($7,364) and DEB ($4,417).
The findings have particular implications for new technologies coming onto the market in the United States, Jaff said. “Without appropriate reimbursement for technology that shows an efficacy benefit over standard technology, those technologies will struggle to be adopted in the US health care market,” he said. “So, these technologies that are used throughout the world may not be available for Medicare providers in the US.”
For more information:
Jaff M. Presented at: Vascular Interventional Advances; Oct. 9-12, 2012; Las Vegas.