Cost-effectiveness of Urea Excipient-based Drug-coated Balloons for Chronic Limb-Threatening Ischemia From Femoropopliteal Disease

Dr. Michel Reijnen, from the University of Twente in Enschede, Netherlands, spoke to attendees on the first day of LINC 2002 about a study to assess the potential cost-effectiveness of drug-coated balloon (DCB) use vs standard-of-care interventions in the Dutch and German healthcare systems. This is important because of a steep increase in health care costs seen over the past decade. Dr. Reijnen and colleagues designed a study utilizing a decision-analytic Markov model using Dutch and German reimbursement data. Two groups were studied: the DCB with Bailout Stenting group vs the “Status Quo” group. Clinical data was pulled from the IN.PACT Global Study for the DCB with Bailout Stenting group (156 subjects with Rutherford classification 4-5, with femoropopliteal lesions) and a systematic literature search for the “Status Quo” group (PTA, DCB, BMS, or DES in cohorts with close to 100% CLTI symptoms [Rutherford 4-6] and primary femoropopliteal lesions). The incremental cost-effectiveness ratio of DCB vs Status Quo was evaluated as the cost per quality-adjusted life year (QALY) gained.

In the analysis of the IN.PACT Admiral DCB, DCB treatment was associated with favorable health economic value in Germany and the Netherlands. DCB use was associated with lower total costs (€1030 Dutch and €513 German) and higher QALYs (0.17 in both), so it’s likely the dominant treatment strategy in both the Dutch and German settings. Higher DCB index procedure costs are offset over 24 months by reduced intervention rates and avoided amputation events. Because this study evaluated just one type of DCB compared with a literature-based comparator, future studies are needed to confirm these results.