Kearns, B.C. and Thomas, S.M. (2017) Cost-effectiveness of superficial femoral artery endovascular interventions in the UK and Germany: a modelling study. BMJ Open, 7 (1). e013460.
Abstract
Objectives: To assess the lifetime costs and cost-effectiveness of 5 endovascular interventions to treat superficial femoral arterial disease. Design: A model-based health economic evaluation. An existing decision analytical model was used, with updated effectiveness data taken from the literature, and updated costs based on purchasing prices. Setting: UK and German healthcare perspectives were considered. Participants: Patients with intermittent claudication of the femoropopliteal arteries eligible for endovascular treatment. Methods: UK and German healthcare perspectives were considered, as were different strategies for re-intervention. Interventions: Percutaneous transluminal angioplasty (PTA) with bail-out bare metal stenting (assumed to represent the existing standard of care, and 4 alternatives: primary bare metal stents, drug-eluting stents, drug-eluting balloons (DEBs) and biomimetic stents). Primary outcome measures: The incremental cost-effectiveness ratio between 2 treatments, defined as the incremental costs divided by the incremental quality-adjusted life years (QALYs). Results: Use of a biomimetic stent, BioMimics 3D, was always estimated to dominate the other interventions, having lower lifetime costs and greater effectiveness, as measured by QALYs. Of the remaining interventions, DEBs were always the most effective, and PTA the least effective. There was uncertainty in the cost-effectiveness results, with key drivers being the costs and effectiveness of the biomimetic stent along with the costs of DEBs. Conclusions: All 4 of the alternatives to PTA were more effective, with the biomimetic stent being the most cost-effective. As there was uncertainty in the results, and all of the interventions have different mechanisms of action, all 4 may be considered to be alternatives to PTA.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 The Authors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 07 Dec 2016 09:52 |
Last Modified: | 17 Jan 2017 13:38 |
Published Version: | https://doi.org/10.1136/bmjopen-2016-013460 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2016-013460 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:108858 |