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DCBs cost-effective for SFA treatment
The use of drug-coated balloons as a strategy for endovascular intervention in the superficial femoral artery is cost-effective, according to data published in the Journal of Vascular Surgery.
However, using more than one DCB per intervention decreased cost-effectiveness significantly, researchers wrote.
“Although balloon angioplasty with bailout stenting has long been considered the standard of practice, a number of emerging therapies may improve the patency rates and, consequently, lower the TLR rates for endovascular treatment of SFA-popliteal disease," Natalie D. Sridharan, MD, MS, from the division of vascular surgery at the University of Pittsburgh Medical Center, and colleagues wrote. “DCBs and DES are two therapies that have emerged in recent years with randomized controlled trial evidence showing superior patency and decreased need for reintervention. The 5-year data for these technologies show possible long-term sustained benefits."
The researchers used meta-analytic data of DCB studies to determine the difference between DCBs, drug-eluting stents, plain old balloon angioplasty (POBA) and bare-metal stents in the treatment of superficial femoral artery disease.
Sridharan and colleagues also analyzed randomized controlled trials that compared DCBP and POBA in the treatment of SFA disease.
According to the study, Sridharan and colleagues extracted HRs to account for the time-to-event primary outcome of target lesion revascularization and calculated ORs for the secondary outcomes of primary patency and major amputation.
A total of 1,352 patients from eight studies were included in the meta-analysis.
The researchers reported that DCB was superior to POBA with respect to TLR over time (pooled HR = 0.41; P < .001).
At 12 months, the risk of for major amputation at 12 months did not significantly differ between groups.
The primary patency in those who received DCB was improved at 12 months compared with those who received POBA (pooled OR = 3.3; P < .001).
The highest primary patency at 1 year was seen in the DES index therapy strategy (79%), followed by DCB (74%), BMS (71%) and POBA (64%), the researchers wrote.
Researchers found an incremental cost of $14,136.10 per additional patent limb for DCB, $38,549.80 per patent limb for DES and $59,748.85 per patent limb for BMS.
Additionally, they found that the primary BMS option was more expensive and less effective than DCB.
Compared with DCB, DES cost $87,377.20 per additional patent limb at 1 year, according to the researchers.
Based on the projected primary patency at 1 year in the decision model, the number needed to treat for DES compared with DCB was 20, Sridharan and colleagues wrote.
At the current reimbursement rate, compared with DES, DCB would cease to be effective if used more than twice per procedure, they wrote.
At 2 years, DCB was the most cost-effective index strategy with the lowest overall cost and highest patency rates, according to the researchers.
“Current data and Medicare reimbursements support the use of DCBs as a cost-effective strategy for endovascular intervention in the SFA,” they wrote. – by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.