Interwoven nitinol stent for PAD cost-effective, linked with low rate of repeat procedures

LAS VEGAS — Compared with four other technologies, an interwoven nitinol stent had the lowest economic impact on hospitals and the lowest rate of repeat procedures, according to an economic analysis presented at VIVA 15.

Brian G. DeRubertis, MD, associate professor of surgery, division of vascular surgery, UCLA Gonda Vascular Center, and colleagues analyzed five endovascular treatments for femoropopliteal peripheral artery disease: the interwoven nitinol stent (Supera, Abbott Vascular), percutaneous transluminal angioplasty (PTA), bare-metal stents, drug-eluting stents and drug-coated balloons (DCB).

All data were compiled from Investigational Device Exemption trials of the respective technologies to show their impact on a similar patient population, DeRubertis said during a press conference.

The researchers analyzed the rates of target lesion revascularization reported for all IDE studies and developed a decision-analytic model to estimate the costs associated with each technology. They used the rate of TLR to estimate the number of reinterventions that would be performed over 3 years if 3-year data were unavailable.

“One of the advantages of this particular study is that it’s modeled out over 3 years,” DeRubertis said in an interview with Cardiology Today’s Intervention. “That’s when we start seeing some of the benefits of these therapies catch up while others may fall behind.”

The estimated 3-year TLR rates based on pooled data were as follows: Supera, 6%; DES, 19.4%; DCB, 24.6%; BMS, 29.2%; and PTA, 46.4%, DeRubertis reported.

According to results presented, Supera had the lowest per-patient cost to Medicare over 3 years ($13,036), followed by DCB ($13,421), DES ($14,845), PTA ($15,166) and BMS ($16,158).

The researchers also calculated the total hospital remaining payment over 3 years divided by the total number of procedures over 3 years to determine the average hospital remaining payment per procedure. This also favored Supera, at $9,926, followed by BMS ($9,885), DES ($9,375), PTA ($8,588) and DCB ($8,442), DeRubertis said.

“As new technology unfolds, one of the issues we have is fitting in these somewhat expensive devices ... and making those work for our patients in a cost-effective fashion,” he said. “To some degree, the upfront cost of the procedure is what we focus on as a specialty, rather than looking at the long-term impact on the patient. From a physician standpoint, we think about what is going to give our patients the best longevity, but don’t always think about it in terms of that the same technology that gives good durability also gives the patient a cost-effective strategy. Analyses like these are important for that reason. In the absence of head-to-head studies comparing two modalities, these are ideal models to compare their long-term impact.”

Supera differs from other stents to treat femoropopliteal PAD because “it’s a series of woven nitinol wires that are closed at each end but not connected anywhere else along the course of the stent,” he said. “The advantage of that is [an] incredible ability to handle torsion and twisting, for increased flexibility. Another big difference is compression resistance and fracture resistance. In areas of heavy calcification, very high mechanical stress and compression, the stent works very well.” by Erik Swain

Reference:

DeRubertis B, et al. Late-Breaking Clinical Trials. Presented at: VIVA 15; Nov. 2-5, 2015; Las Vegas.

Disclosure: The study was funded by Abbott Vascular. DeRubertis reports consulting and speaking for Abbott Vascular, Boston Scientific and Medtronic/Covidien.