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Cost-Effectiveness of Percutaneous Treatment of Iliac Artery Occlusive Disease in the United States

¹ Decision Analysis and Technology Assessment Group, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Zero Emerson PI., Ste. 2H, Boston, MA 02114.
² Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
³ Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
⁴ Information Systems, Brigham and Women's Hospital, 1249 Boylston St., Boston, MA 02215.
⁵ Program for the Assessment of Radiological Technology, Department of Epidemiology and Biostatistics, Rm. EE21-40a, Erasmus Medical Center, Rotterdam, P. O. Box 1738, 3000 DR Rotterdam, the Netherlands.

OBJECTIVE. The costs of percutaneous transluminal angioplasty and stent placement for iliac artery occlusive disease in the United States were assessed and the cost-effectiveness was evaluated.

MATERIALS AND METHODS. Lifetime costs and quality-adjusted life expectancy were estimated using a Markov decision model for a hypothetic cohort of patients with life-style-limiting claudication caused by an iliac artery stenosis for whom a percutaneous intervention was indicated. Various percutaneous treatment strategies were evaluated, each consisting of an initial intervention followed by a secondary intervention. Procedures considered were angioplasty alone and angioplasty with selective stent placement.

RESULTS. From the perspective of the interventional radiology department, angioplasty with selective stent placement costs more than angioplasty alone ($2926 versus $2106). Taking into account follow-up costs and procedures for long-term failures, the cost differential was reduced because of a lower failure rate of selective stent placement ($13,158 versus $12,458, respectively). Treatment strategies using angioplasty with selective stent placement (as an initial procedure or including reintervention) dominated treatment strategies using angioplasty alone (incremental cost-effectiveness ratio was $7,624-8,519 per quality-adjusted life-year gained).

CONCLUSION. Angioplasty with selective stent placement is a cost-effective treatment strategy compared with angioplasty alone in the treatment of intermittent claudication in the United States.

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