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DCB cost-effective for treatment of femoropopliteal disease
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LAS VEGAS — Treatment with a drug-coated balloon was cost-effective and perhaps economically dominant compared with a standard balloon in patients with femoropopliteal disease, according to data presented at VIVA 15.
David J. Cohen, MD, MSc, and colleagues conducted a prospective economic study alongside the IN.PACT SFA II trial of a drug-coated balloon (DCB; IN.PACT Admiral, Medtronic) compared with standard percutaneous transluminal angioplasty (PTA) in 181 patients with symptomatic femoropopliteal disease over 24 months.
David J. Cohen
The researchers assessed cost-effectiveness by cost per quality-adjusted life year (QALY).
Patients who received DCB had average initial hospital costs that were $1,129 higher than for patients assigned PTA, mostly because the DCB is more expensive than the standard balloon, according to Cohen.
“There was a reduction in the need for provisional stenting in the DCB group, probably not because of the angiographic results, but reflecting the operators’ comfort with that approach,” Cohen, from Saint-Luke’s Mid America Heart Institute, Kansas City, Missouri, said during a press conference.
However, follow-up costs related to the target limb were $1,211 less in the DCB group compared with the PTA group, Cohen, said, noting that a reduction in hospitalizations for repeat revascularization were the main driver.
Therefore, he said, total costs for both groups were almost identical (DCB group, $11,277; PTA group, $11,359; P = .97). When adjustment was made to account for one extreme outlier from the DCB group, DCB were lower in total costs by approximately $700, he said.
On the basis of these findings, Cohen said DCB were economically dominant — lower costs and better outcomes — compared with standard balloons. Using a threshold of $50,000 per QALY gained (a common threshold in the United States), the probability of DCB being economically attractive was approximately 69%, and using a threshold of $150,000 per QALY gained, the probability was approximately 80%, he noted.
“Based on these findings, we conclude that for patients similar to those enrolled in the IN.PACT SFA II trial, the IN.PACT Admiral DCB appears to be economically attractive (i.e., cost-effective) compared to standard PTA based on current U.S. standards, Cohen concluded. ˗ by Erik Swain
Reference:
Cohen D. Late-Breaking Clinical Trials. Presented at: VIVA 15; Nov. 2-5, 2015; Las Vegas.
Perspective
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Douglas E. Drachman, MD
The IN.PACT SFA Health Economics Study provides insight into the cost-effectiveness of DCB vs. PTA in treatment of femoropopliteal peripheral artery disease. While DCB increases the cost of index hospitalization compared to PTA, the reduction of repeat revascularization results in long-term cost reduction, and improves QALY. These findings make DCB an attractive option: economically dominant, and potentially reducing the need for a chronic implant (stent) to improve long-term patency. While the treatment paradigm may shift to “leave nothing behind,” we will eagerly await head-to-head comparisons of DCB vs. stents (either BMS or DES) and clarification of the potential role for atherectomy in the treatment of femoropopliteal PAD.
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