COST-CONSEQUENCE ANALYSIS OF COVERED BALLOON-EXPANDABLE STENTS USING EXTRAPOLATED 3-YEAR OUTCOMES FOR AORTOILIAC OCCLUSIVE DISEASE IN THE UK
Author(s)
Kashfa Iqbal, MA1, Lewis Meecham, MD FRCS2, Ashish Patel Patel, PhD FRCS3, Julie Lyon, BSc4.
1EMEA HEOR, Gore UK Medical Limited, Livingstone, United Kingdom, 2University Hospital of Wales, Cardiff, United Kingdom, 3Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom, 4Gore UK Medical Limited, Livingstone, United Kingdom.
1EMEA HEOR, Gore UK Medical Limited, Livingstone, United Kingdom, 2University Hospital of Wales, Cardiff, United Kingdom, 3Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom, 4Gore UK Medical Limited, Livingstone, United Kingdom.
OBJECTIVES: In aortoiliac occlusive disease (AIOD), variation in device acquisition costs across covered balloon-expandable stents (CBES) may be offset by differences in downstream clinical events. This study evaluated the cost consequences of CBES 1 with alternative CBES 2 and CBES 3 in the UK setting.
METHODS: A 3-year cohort-based cost-consequence model was developed from a UK hospital perspective. Clinical inputs, including freedom from target lesion revascularisation (fTLR) and major amputation, were derived from a systematic literature review. CBES 2 and CBES 3 had limited published follow-up data (12-month); 24- and 36-month fTLR estimates were generated using a time-to-event extrapolation framework. Costs included device acquisition, TLR procedures and major amputation. Scenario analyses were conducted across hospital volumes (25-100 procedures/year). Key parameters were varied in deterministic sensitivity analyses (±20%).
RESULTS: CBES 1 entailed higher device acquisition costs versus CBES 2 and CBES 3 (£2,914 vs £2,209 and £2,759 £ per patient) but lower downstream costs. TLR-related costs were reduced (£982 vs £1,669 and £1,976) and amputation costs were minimal (£24 vs £429 and £109), resulting in total per-patient costs of £3,920 for CBES 1 versus £4,299 and £4,844 (incremental cost: −£379 and -£924). Cost differences were driven by lower reintervention rates (0.08 vs 0.14 and 0.16 TLR events per patient). At hospital level, repeat procedures and associated costs were reduced with CBES 1 throughout, with larger absolute savings in higher-volume centres. Deterministic sensitivity analysis identified 36-month TLR rates as the primary drivers of incremental cost. Results remained directionally robust across the tested ranges.
CONCLUSIONS: Use of CBES 1 was associated with lower reintervention rates, offsetting higher device acquisition expenditure and reducing overall costs. Findings were robust to parameter uncertainty and consistent across hospital volumes, indicating that CBES 1 may reduce downstream costs from a UK hospital perspective.
METHODS: A 3-year cohort-based cost-consequence model was developed from a UK hospital perspective. Clinical inputs, including freedom from target lesion revascularisation (fTLR) and major amputation, were derived from a systematic literature review. CBES 2 and CBES 3 had limited published follow-up data (12-month); 24- and 36-month fTLR estimates were generated using a time-to-event extrapolation framework. Costs included device acquisition, TLR procedures and major amputation. Scenario analyses were conducted across hospital volumes (25-100 procedures/year). Key parameters were varied in deterministic sensitivity analyses (±20%).
RESULTS: CBES 1 entailed higher device acquisition costs versus CBES 2 and CBES 3 (£2,914 vs £2,209 and £2,759 £ per patient) but lower downstream costs. TLR-related costs were reduced (£982 vs £1,669 and £1,976) and amputation costs were minimal (£24 vs £429 and £109), resulting in total per-patient costs of £3,920 for CBES 1 versus £4,299 and £4,844 (incremental cost: −£379 and -£924). Cost differences were driven by lower reintervention rates (0.08 vs 0.14 and 0.16 TLR events per patient). At hospital level, repeat procedures and associated costs were reduced with CBES 1 throughout, with larger absolute savings in higher-volume centres. Deterministic sensitivity analysis identified 36-month TLR rates as the primary drivers of incremental cost. Results remained directionally robust across the tested ranges.
CONCLUSIONS: Use of CBES 1 was associated with lower reintervention rates, offsetting higher device acquisition expenditure and reducing overall costs. Findings were robust to parameter uncertainty and consistent across hospital volumes, indicating that CBES 1 may reduce downstream costs from a UK hospital perspective.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE8
Topic
Economic Evaluation, Medical Technologies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas