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Cost-Effectiveness Analysis of Infrapopliteal Drug-Eluting Stents

  • Clinical Investigation
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Abstract

Introduction

There are no cost-utility data about below-the-knee placement of drug-eluting stents. The authors determined the cost-effectiveness of infrapopliteal drug-eluting stents for critical limb ischemia (CLI) treatment.

Methods

The event-free individual survival outcomes defined by the absence of any major events, including death, major amputation, and target limb repeat procedures, were reconstructed on the basis of two published infrapopliteal series. The first included spot Bail-out use of Sirolimus-eluting stents versus bare metal stents after suboptimal balloon angioplasty (Bail-out SES).The second was full-lesion Primary Everolimus-eluting stenting versus plain balloon angioplasty and bail-out bare metal stenting as necessary (primary EES). The number-needed-to-treat (NNT) to avoid one major event and incremental cost-effectiveness ratios (ICERs) were calculated for a 3-year postprocedural period for both strategies.

Results

Overall event-free survival was significantly improved in both strategies (hazard ratio (HR) [confidence interval (CI)]: 0.68 [0.41–1.12] in Bail-out SES and HR [CI]: 0.53 [0.29–0.99] in Primary EES). Event-free survival gain per patient was 0.89 (range, 0.11–3.0) years in Bail-out SES with an NNT of 4.6 (CI: 2.5–25.6) and a corresponding ICER of 6,518€ (range 1,685–10,112€). Survival gain was 0.91 (range 0.25–3.0) years in Primary EES with an NNT of 2.7 (CI: 1.7–5.8) and an ICER of 11,581€ (range, 4,945–21,428€) per event-free life-year gained. Two-way sensitivity analysis showed that stented lesion length >10 cm and/or DES list price >1000€ were associated with the least economically favorable scenario in both strategies.

Conclusions

Both strategies of bail-out SES and primary EES placement in the infrapopliteal arteries for CLI treatment exhibit single-digit NNT and relatively low corresponding ICERs.

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Abbreviations

CLI:

Critical limb ischemia

DES:

Drug-eluting stents

SES:

Sirolimus-eluting stents

EES:

Everolimus-eluting stents

NNT:

Number needed to treat

ICER:

Incremental cost-effectiveness ratio

HR:

Hazard ratio

AUC:

Area under the curve

ARR:

Absolute risk reduction

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All authors state that they have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Interventional Radiology, School of Medicine, Patras University Hospital, 26504, Rion, Greece

    Konstantinos Katsanos, Dimitris Karnabatidis, Athanasios Diamantopoulos, Stavros Spiliopoulos & Dimitris Siablis

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  1. Konstantinos Katsanos
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  2. Dimitris Karnabatidis
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  3. Athanasios Diamantopoulos
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  4. Stavros Spiliopoulos
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  5. Dimitris Siablis
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Correspondence to Konstantinos Katsanos.

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Katsanos, K., Karnabatidis, D., Diamantopoulos, A. et al. Cost-Effectiveness Analysis of Infrapopliteal Drug-Eluting Stents. Cardiovasc Intervent Radiol 36, 90–97 (2013). https://doi.org/10.1007/s00270-012-0370-8

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  • DOI: https://doi.org/10.1007/s00270-012-0370-8

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