VESS22. Implementation of Drug-Eluting Stents for the Treatment of Femoropopliteal Disease Provides Significant Cost-to-System Savings: A Single-State Outpatient Simulation

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Initial data on drug-eluting stents (DES) shows they may increase durability of endovascular treatment of superficial femoral artery (SFA) disease compared to traditional bare-metal stents (BMS). Observed decreased target lesion revascularization (TLR) rates have potential for savings despite increased initial costs. The purpose of this study was to simulate a transition from BMS to DES over 5 years, evaluating the overall cost impact of that transition. Florida state ambulatory databases were searched for patients undergoing SFA stenting in 2013 (Current Procedural Terminology codes 37226 and 37227). A model was developed to estimate the impact of progressive transition from BMS to DES over a 5-year horizon in this population. Cost estimates were determined from available cost-to-charge ratios. 2013 was the initial year for the model with each subsequent year based on the expected number of interventions per year. Up to one TLR per patient was assumed for the model. TLR rates for DES and other parameter estimates were based on pooled data from the literature. Institutional data were used to estimate that up to 48% of lesions would fit the instructions for use for the Zilver PTX, currently the only United States Food and Drug Administration-approved DES for peripheral interventions. Net budget impact was expressed as difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only. Multiple sensitivity analyses were performed on the base scenario. A total of 4107 peripheral interventions fit our study. Overall cost for these procedures in the Florida database was $51,362,142.00. In the base case, DES was introduced at a rate of 8% per year up to 48% at the end of the model. This resulted in an overall cost savings of $1,688,953.72 compared to the model with BMS alone. Net budget impact by year with DES vs BMS only is illustrated in the Fig, where a negative net budget impact indicates savings. Sensitivity analyses, including slower adoption of DES up to 24% at 5 years, a 20% increase in TLR rates per year for the DES, and a 10% reduction in TLR rates per year for BMS still resulted in a net savings. As long as the additional cost of a DES compared to BMS is less than $677, the DES model remains less expensive. The adoption of drug eluting stents in lieu of traditional BMS can lead to significant cost savings in a single state system over a short time horizon.