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Cost-Effectiveness of Drug-Coated Balloon Angioplasty Compared With Conventional Balloon Angioplasty for

Chin Cheung Andrew Lau1, Farah Irani2, Luming Shi3

  • 1Duke NUS Medical School, Singapore.

Value in Health Regional Issues
|June 30, 2022
PubMed

Insights

Drug-coated balloon (DCB) angioplasty shows potential cost-effectiveness for arteriovenous fistula/graft dysfunction compared to conventional angioplasty. Considering abandonment costs reveals DCB as weakly cost-effective in this patient group.

Area of Science:

  • Vascular Surgery
  • Health Economics
  • Interventional Cardiology

Background:

  • Arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) are crucial for hemodialysis access.
  • Dysfunction of AVFs/AVGs necessitates interventions like angioplasty.
  • Drug-coated balloon (DCB) angioplasty offers a potential alternative to conventional balloon angioplasty (cPTA).

Purpose of the Study:

  • To evaluate the cost-effectiveness of DCB angioplasty versus cPTA for AVF/AVG dysfunction.
  • To incorporate AVF/AVG abandonment costs into the economic analysis.
  • To assess cost-effectiveness from a Singapore healthcare perspective.

Main Methods:

  • A Markov model-based economic evaluation was conducted.
  • The model included costs of AVF/AVG creation, maturation, and routine interventions.
  • Effectiveness was measured in quality-adjusted life-years (QALYs).
  • Cost-effectiveness was determined using incremental net monetary benefit (NMB) at a willingness-to-pay threshold of S$87,000.

Main Results:

  • DCB angioplasty was not cost-effective at a 3-year horizon (NMB = -S$1424).
  • DCB was cost-effective at 1-year (NMB = S$356) and 6-year (NMB = S$3738) horizons.
  • The probability of DCB being cost-effective was 34.5% at 3 years, and 58.6% (1-year) and 59.9% (6-year) at longer horizons.
  • DCB showed a trend towards fewer AVF/AVG abandonments, but this was not statistically significant (P = 0.21).

Conclusions:

  • DCB angioplasty may be weakly cost-effective compared to cPTA for treating AVF/AVG flow dysfunction when abandonment costs are considered.
  • AV access creation and maturation costs are significant factors in assessing DCB cost-effectiveness.
  • Further research may refine the understanding of DCB's long-term economic value in vascular access interventions.
Abstract

Keywords:
arteriovenous accesscost effectiveness analysisdrug coated balloonend stage renal disease

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