Intravascular brachytherapy for peripheral vascular disease.
Vitali Gorenoi1, Charalabos-Markos Dintsios, Matthias P Schönermark
1Medizinische Hochschule Hannover, Abteilung für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Hannover, Deutschland.
GMS Health Technology Assessment
|February 4, 2011
Summary
Intravascular brachytherapy effectively reduces restenosis after balloon angioplasty for peripheral artery disease (PAOD). However, its cost-effectiveness remains unclear, and it is not recommended after stenting due to increased occlusion risks.
Area of Science:
- Cardiovascular Medicine
- Interventional Radiology
- Health Economics
Background:
- Peripheral artery occlusive disease (PAOD) is commonly treated with percutaneous transluminal angioplasty (PTA), often with stenting.
- Intravascular brachytherapy (IVBT) is an adjunct therapy aimed at reducing restenosis rates post-PTA.
- The efficacy, cost-effectiveness, and ethical implications of IVBT in PAOD require thorough evaluation.
Purpose of the Study:
- To assess the medical efficacy of IVBT in reducing restenosis in PAOD patients.
- To evaluate the cost-effectiveness of IVBT within the German healthcare system.
- To explore the ethical, social, and legal aspects of IVBT use in PAOD.
Main Methods:
- A systematic literature search identified randomized controlled trials (RCTs) published from 2002 onwards.
- Meta-analysis synthesized data from seven RCTs comparing IVBT with no IVBT.
- Health economic modeling utilized clinical data from meta-analysis and German Diagnosis Related Group (G-DRG-2007) cost data.
Main Results:
- IVBT significantly reduced restenosis rates at 6-12 months post-balloon dilatation (RR 0.62) and delayed recurrence at five years.
- IVBT also showed a significant reduction in restenosis after PTA with stenting (RR 0.76), but with increased late thrombotic occlusions.
- Health economic analysis indicated incremental costs per avoided restenosis, with negative ratios for IVBT after stenting, suggesting cost-effectiveness challenges.
Conclusions:
- IVBT is medically recommended for reducing restenosis after balloon dilatation in PAOD at one year.
- The health economic justification for IVBT remains uncertain, particularly after stenting.
- Current data do not support IVBT use after stenting in PAOD due to medical and economic concerns; patient informed consent is crucial.
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