ILIAC ARTERIAL OCCLUSIVE DISEASE - COST-EFFECTIVENESS ANALYSIS OF STENT PLACEMENT VERSUS PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

PURPOSE: To evaluate the relative benefits and cost-effectiveness of t reating iliac arterial occlusive disease with various interventions. M ATERIALS AND METHODS: Cost-effectiveness was analyzed in a hypothetica l cohort of patients with intermittent claudication caused by an iliac arterial stenosis. primary stent placement, percutaneous transluminal angioplasty (PTA), and PTA with selective stent placement were analyz ed. Reduction in the risk of failure after primary stent placement ver sus that after PTA with selective stent placement, quality of life, an d cost data were derived from results of a randomized, controlled tria l. Complication rates, patency results, and the reduction in risk of f ailure were derived from a published meta-analysis. RESULTS; PTA with selective stent placement yielded equivalent complication rates. paten cy results, and quality-of-life outcomes compared with those of primar y stent cement, and the latter cost $957 less (95% confidence interval = $726, $1,188). PTA with selective-stent placement was more expensiv e than PTA alone but yielded higher patency results (relative risk of long-term failure, 0.61; 95% confidence interval = 0.49, 0.75) and qua lity-adjusted life expectancy (0.2 quality-adjusted life year [QALY] g ained) and had an incremental cost-effectiveness ratio of less than $2 0,000 per QALY gained. CONCLUSION: PTA with selective stent placement is a cost-effective treatment strategy compared with primary stent pla cement or PTA alone in the treatment of intermittent claudication caus ed by an iliac arterial stenosis.