Jaff MR, Geisler BP, Fujihara M, Schneider PA, Gray WA, Pietzsch JB. Management of arterial dissections following PTA is cost-effective: results of an analysis with the Intact (Tack) vascular device [Session 60, slides in pdf]. Presentation at the Veith Symposium, New York City, November 21, 2019. Available at: www.veithsymposium.org/abstracts/2019/vei/731.pdf. Accessed July 22, 2020.

Objectives. Dissection after percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries can negatively affect both short- and long-term patient outcomes. The Tack endovascular system (Intact Vascular, Wayne, PA) is a novel device designed to provide durable repair of post-PTA dissections in the superficial femoral and infrapopliteal arteries, while limiting the metal footprint. Our objective was to study the cost-effectiveness of Tack use in A/B (non-severe) vs. C+ (severe) vs. all dissections.

Methods. Using data from the Toba II PTA study cohort, we created a decision analytic model extrapolated to a 24-month horizon. For A and B dissections, performance was compared to data from a matched PTA-only cohort. For C+ dissections, performance was compared to data from a recent meta-analysis of bare metal stent performance and drug-eluting stent trial data. The U.S. Medicare reimbursement fee schedule was used as a proxy for procedure costs. Device costs were based on average selling prices and the list price for the Tack device. Health-economic outcomes included the index procedure cost; the costs of reintervention at 24 months after the index procedure, based on projected target lesion revascularization (TLR); and the estimated incremental cost-effectiveness ratio (ICER) expressed in dollars per quality-adjusted life year (QALY). Incremental QALYs were calculated using a TLR-associated QALY decrement.

Results. For the treatment of severe dissections,use of the Tack device offered some clinical improvement and concurrent cost savings when compared to stent treatment (Figure 1). Overall savings from use of the Tack device were based largely on lower reintervention costs ($3,046 for stent treatment vs. $2,041 for Tack intervention). Combined analysis across dissections of all severity showed substantive reductions in projected 24-month TLR events, at a minor increase in 24-month costs. Overall, the Tack device provided improved outcomes and concurrent cost savings.

Conclusions. Untreated post-PTA dissections of all severity lead to suboptimal outcomes and an additional economic burden. Management of post-PTA dissections using the Tack system improves clinical outcomes and is cost-effective and possibly cost-saving at the 24-month analysis horizon. Information about dissection grade-specific outcomes of comparator approaches are limited and warrant further study.