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Cost-Effectiveness of Drug-Coated Balloon Angioplasty versus Plain Old Balloon Angioplasty for Arteriovenous Fistula Stenosis

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  • Venous Interventions
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Abstract

Objective

To compare the cost-effectiveness of drug-coated balloon angioplasty (DCB) versus plain old balloon angioplasty (POBA) for treatment of arteriovenous fistula (AVF) stenosis.

Methods

A Markov model was created to compare DCB versus POBA for AVF stenosis over a 2-year time horizon from a United States payer’s perspective. Probabilities related to complications, restenosis, retreatment, and all-cause mortality were obtained from published literature. Costs were calculated using Medicare reimbursement rates and data from published cost analyses, inflation-adjusted to 2021. Health outcomes were measured with quality-adjusted life years (QALY). Probabilistic and deterministic sensitivity analyses were performed with a willingness-to-pay threshold of $100,000/QALY.

Results

Base case calculation showed better quality-of-life outcomes but increased cost with POBA compared to DCB, with an incremental cost-effectiveness ratio of $27,413/QALY, making POBA the more cost-effective strategy in the base case model. Sensitivity analyses showed that DCB becomes cost-effective if the 24-month mortality rate after DCB is no more than 3.4% higher than that after POBA. In secondary analyses where mortality rates were equalized, DCB was more cost-effective than POBA until its additional cost reached more than $4213 per intervention.

Conclusion

When modeled from a payer’s perspective over 2 years, the cost utility of DCB versus POBA varies with mortality outcomes. POBA is cost-effective if 2-year all-cause mortality after DCB is greater than 3.4% higher than after POBA. If 2-year mortality after DCB is less than 3.4% higher than after POBA, DCB is cost-effective until its additional cost per procedure exceeds $4213 more than POBA.

Level of Evidence IV: Historically Controlled Study.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

    Alice L. Zhou, Xiao Wu, Jiwon Youm, Michael B. Heller & Alexander Lam

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  1. Alice L. Zhou
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  2. Xiao Wu
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Correspondence to Alice L. Zhou.

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Zhou, A.L., Wu, X., Youm, J. et al. Cost-Effectiveness of Drug-Coated Balloon Angioplasty versus Plain Old Balloon Angioplasty for Arteriovenous Fistula Stenosis. Cardiovasc Intervent Radiol 46, 1221–1230 (2023). https://doi.org/10.1007/s00270-023-03403-3

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  • DOI: https://doi.org/10.1007/s00270-023-03403-3

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