THE COST-EFFECTIVENESS OF TREATMENT OF SHORT OCCLUSIVE LESIONS IN THEFEMOROPOPLITEAL ARTERY - BALLOON ANGIOPLASTY VERSUS ENDARTERECTOMY

Objective: To compare the short- and long-term outcome and the costs i nvolved in balloon angioplasty (BA) and thrombo-endarterectomy (EA) of shout femoropopliteal occlusions. Design: Retrospective study. Patien ts and methods: Forty-one lower limbs underwent EA from 1980 until 198 8 and BA was performed in 62 limbs between 1988 and 1993. The two grou ps of patients were well matched for age, gender, cardiovascular risk- factors and the length of the femoropopliteal occlusions. In addition to clinical follow-up colour-Duplex scanning and intraarterial DSA wer e performed. Complete occlusions or significant restenoses were consid ered failure of the reconstruction. Actual costs were calculated by th e hospital economic administration. Results: The 3-year primary patenc y in EA patients was 87% and in the BA group 44% (p = 0.0002). Redo pr ocedures were required in seven (17%) patients with EA and in 24 (39%) with BA. Patency after redo procedures, i.e. tertiary patency, was 94 % and 74% after 3 years in the EA and BA group respectively (p = 0.14) . The mean cost of the primary treatment was higher in EA than in BA p atients (p < 0.001). Mean total treatment costs including the expenses involved with redo procedures i were also higher in the group with EA than with BA (p < 0.001). However, the cost-effectiveness expressed a s the total costs per month tertiary patency, was not significantly di fferent for the two treatment groups; in patients with EA the ratio of total treatment costs and tertiary patency was NFl 309, and in patien ts with BA NFl 287. Conclusion: Contrary to the general view the expen ses associated with surgical treatment are comparable with those of an endovascular procedure, if the costs are expressed as a cost-to-paten cy ratio.