Pietzsch JB, Weber SA, Pietzsch ML, Zeller T. The impact of new endovascular therapies for femoropopliteal arterial disease on therapy utilization and case volumes in Germany, 2009–2013 [Presentation to the 2015 annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research, abstract PMD126]. Value Health. 2015;18(7):A366; doi: 10.1016/j.jval.2015.09.728.

Objectives. Our objective was to estimate the impact of the availability of new endovascular therapies on treatment volumes for femoropopliteal arterial disease in the German healthcare system. Germany was among the first markets to adopt and reimburse new endovascular techniques, including drug-coated balloons (DCB), drug-eluting stents (DES), and the latest atherectomy devices.

Methods. We collected therapy-specific procedure volumes for the five-year period 2009–2013 from the German Federal Statistics Office for plain balloon angioplasty (PTA), DCB, BMS, DES, and atherectomy. In addition, surgical bypass and relevant amputation procedure volumes were collected. To assess general changes in hospitalization volumes of patients with primary diagnosis of peripheral artery disease (PAD), we also obtained ICD-10-specific discharge information. We evaluated the five-year growth for each of the studied treatment modalities and analyzed their relative utilization levels in the latest reported year, 2013.

Results. Endovascular procedure volumes grew from 73,927 in 2009 to 98,730 in 2013 (+34%), while bypass surgery volumes decreased from 31,970 to 29,042 (–9%), for a combined growth of 21% in total procedure volumes. Hospitalizations with primary diagnosis of PAD increased by 11% in this period (168,845 to 187,563). At the same time, lower extremity amputations remained stable (+1.6%). However, a substantial shift from major to minor amputations could be observed (–14.5%; +10.5%).

In 2013, PTA, DCB, BMS, DES, and atherectomy constituted 51.6%, 16.3%, 28.0%, 0.9%, and 3.2% of the total endovascular case volume. DCBs exhibited the most rapid growth, with their relative share of endovascular interventions increasing from 6.2% in 2009 to 16.3% in 2013.

Conclusions. Five-year national data from the German healthcare system demonstrate that the availability of new endovascular therapies has led to substantial growth in femoropopliteal arterial disease procedure volumes, expanding the treated population and partially replacing surgical bypass treatment. Concurrently, our results suggest a trend toward improved limb salvage.