Pietzsch JB, Geisler BP, Garner AM, Zeller T, Jaff MR. Economic analysis of endovascular interventions for femoropopliteal arterial disease: a systematic review and budget impact model for the United States and Germany. Catheter Cardiovasc Interv. 2014;84(4):546–554; doi: 10.1002/ccd.25536.

Objectives. Bare metal stents (BMS), drug-coated balloons (DCB), and drug-eluting stents (DES) are associated with lower target lesion revascularization (TLR) probabilities than percutaneous transluminal angioplasty (PTA), but the economic impact is unknown. Our objective was to study the economic impact on payers and providers of the four main endovascular strategies for the treatment of infrainguinal peripheral artery disease.

Methods. In December 2012, PubMed and Embase were systematically searched for studies with TLR as an endpoint. The 24-month probability of TLR for each treatment was weighted by sample size. A decision-analytic Markov model was used to assess the budget impact—from the perspectives of payers and facility-providers—of the four index procedure strategies: bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stent (DES), and percutaneous transluminal balloon angioplasty (PTA). Base cases were developed from the perspectives of the U.S. Medicare system and the German statutory sickness fund, using current (2013) reimbursement rates.

Results. Our analysis incorporated data from 13studies representing a total of 2,406 subjects. The reported probability of TLR in the identified studies varied widely, particularly following treatment with BMS or PTA. The pooled 24-month probabilities were 28.1%,14.3%, 19.3%, and 40.3% for BMS, DCB, DES, and PTA, respectively.

The drug-eluting strategies had a lower projected budget impact over 24 months compared to BMS and PTA in both the U.S. Medicare (BMS $13,802; DCB $10,214; DES: $12,904; and uncoated balloons $13,114) and German public healthcare systems (BMS €4,026; DCB €3,619; DES €3,632; PTA €4,290).

Conclusions. Compared to BMS and PTA, DCB and DES are associated with lower probabilities of target lesion revascularization and cost savings for U.S. and German payers.