Radiology, Vol 208, 641-648, Copyright © 1998 by Radiological Society of North America

ARTICLES

Iliac arterial occlusive disease: cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty. Dutch Iliac Stent Trial Study Group

JL Bosch, E Tetteroo, WP Mali and MG Hunink
Dept of Health Sciences, University of Groningen, The Netherlands.

PURPOSE: To evaluate the relative benefits and cost-effectiveness of treating iliac arterial occlusive disease with various interventions. MATERIALS AND METHODS: Cost-effectiveness was analyzed in a hypothetical 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 analyzed. Reduction in the risk of failure after primary stent placement versus that after PTA with selective stent placement, quality of life, and cost data were derived from results of a randomized, controlled trail. Complication rates, patency results, and the reduction in risk of failure were derived from a published meta- analysis. RESULTS: PTA with selective stent placement yielded equivalent complication rates, patency results, and quality-of-life outcomes compared with those of primary stent placement, and the latter cost +957 less (95% confidence interval = +726, +1,188). PTA with selective stent placement was more expensive than PTA alone but yielded higher patency results (relative risk of long-term failure, 0.61; 95% confidence interval = 0.49, 0.75) and quality-adjusted life expectancy (0.2 quality-adjusted life year [QALY] gained) and had an incremental cost-effectiveness ratio of less than +20,000 per QALY gained. CONCLUSION: PTA with selective stent placement is a cost-effective treatment strategy compared with primary stent placement or PTA alone in the treatment of intermittent claudication caused by an iliac arterial stenosis.

This article has been cited by other articles:

				R. Ouwendijk, M. de Vries, T. Stijnen, P. M. T. Pattynama, M. R. H. M. van Sambeek, J. Buth, A. V. Tielbeek, D. A. van der Vliet, L. J. SchutzeKool, P. J. E. H. M. Kitslaar, et al. Multicenter Randomized Controlled Trial of the Costs and Effects of Noninvasive Diagnostic Imaging in Patients with Peripheral Arterial Disease: The DIPAD Trial Am. J. Roentgenol., May 1, 2008; 190(5): 1349 - 1357. [Abstract] [Full Text] [PDF]

				D. van Helvoort-Postulart, C. D. Dirksen, P. J. Nelemans, A. A. Kroon, A. G. H. Kessels, P. W. de Leeuw, G. B. C. Vasbinder, J. M. A. van Engelshoven, and M. G. M. Hunink Renal Artery Stenosis: Cost-effectiveness of Diagnosis and Treatment Radiology, August 1, 2007; 244(2): 505 - 513. [Abstract] [Full Text] [PDF]

				M. de Vries, R. Ouwendijk, K. Flobbe, P. J. Nelemans, A. G. Kessels, G. H. Schurink, J. A. van der Vliet, F. M. J. Heijstraten, P. W. M. Cuypers, L. E. M. Duijm, et al. Peripheral Arterial Disease: Clinical and Cost Comparisons between Duplex US and Contrast-enhanced MR Angiography--A Multicenter Randomized Trial. Radiology, August 1, 2006; 240(2): 401 - 410. [Abstract] [Full Text] [PDF]

				C. F. Kugler and G. Rudofsky The challenges of treating peripheral arterial disease Vascular Medicine, May 1, 2003; 8(2): 109 - 114. [Abstract] [PDF]

				S. J. Karlik Visualizing Radiologic Data Am. J. Roentgenol., March 1, 2003; 180(3): 607 - 619. [Full Text] [PDF]

				P. Faries, N. J. Morrissey, V. Teodorescu, E. C. Gravereaux, J. A. Burks JR, A. Carroccio, K. C. Kent, L. H. Hollier, and M. L. Marin Recent Advances in Peripheral Angioplasty and Stenting Angiology, November 1, 2002; 53(6): 617 - 626. [Abstract] [PDF]

				J. L. Bosch, C. Haaring, M. F. Meyerovitz, K. A. Cullen, and M. G. M. Hunink Cost-Effectiveness of Percutaneous Treatment of Iliac Artery Occlusive Disease in the United States Am. J. Roentgenol., August 1, 2000; 175(2): 517 - 521. [Abstract] [Full Text] [PDF]

				J. L. Bosch, Y. van der Graaf, and M. G. M. Hunink Health-Related Quality of Life After Angioplasty and Stent Placement in Patients With Iliac Artery Occlusive Disease : Results of a Randomized Controlled Clinical Trial Circulation, June 22, 1999; 99(24): 3155 - 3160. [Abstract] [Full Text] [PDF]

				S. O. de Vries, K. Visser, J. A. de Vries, J. B. Wong, M. C. Donaldson, and M. G. M. Hunink Intermittent Claudication: Cost-effectiveness of Revascularization versus Exercise Therapy Radiology, January 1, 2002; 222(1): 25 - 36. [Abstract] [Full Text] [PDF]