Cost-effectiveness of percutaneous treatment of iliac artery occlusive disease in the United States.

Abstract

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. 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. 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). 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.