LONG AND COMPLEX FEMOROPOPLITEAL SEGMENT LESION TREATMENTS IN FRANCE: AN ANALYSIS OF THE FRENCH NATIONAL HOSPITAL DISCHARGE DATABASE
Author(s)
Charlène Tournier, MS1, Yann Gouëffic, MD, PhD2, Claire Leboucher, MS1, Gilles Chatellier, MD, PhD2, Lucie de Léotoing, PharmD3.
1Inizio Ignite Putnam Creativ-Ceutical, Paris, France, 2Groupe Hospitalier Paris St Joseph, Paris, France, 3Market Access Strategy, W.L. Gore & Associates, Paris, France.
1Inizio Ignite Putnam Creativ-Ceutical, Paris, France, 2Groupe Hospitalier Paris St Joseph, Paris, France, 3Market Access Strategy, W.L. Gore & Associates, Paris, France.
OBJECTIVES: Patients with lower-limb peripheral arterial disease (LLPAD) are at high risk of mortality and amputation. Our study aimed to compare clinical and economic outcomes in patients treated for long and complex femoropopliteal lesions with dedicated covered vascular endoprostheses (endobypass) versus open surgery (OS) in France.
METHODS: This retrospective, population-based study used the French National Health Data System. Patients with LLPAD hospitalized between January 2018 and December 2022 were identified from a combination of diagnosis, procedure codes and endoprosthesis types. We conducted a 1:3 case-control study by matching patients treated with endobypass with those undergoing OS, using a propensity score incorporating demographic data, disease severity and clinical characteristics to ensure baseline comparability. Outcomes of interest were death, myocardial infarction, stroke, major amputation, major adverse cardiovascular events (MACE; first occurrence of mortality, stroke or myocardial infarction), major adverse limb events (MALE; first occurrence of major amputation or vascular reintervention) and vascular reinterventions. Costs were calculated from the National Health Insurance perspective.
RESULTS: The matched cohort comprised 2,246 and 6,738 patients undergoing endobypass and OS, respectively. Risk of death (hazard ratio [HR]: 1.11; p=0.1335), myocardial infarction (HR: 1.15; p=0.1719) and stroke (HR: 1.05; p=0.6248) were similar between the groups. OS patients were at higher risk of major amputation (HR: 1.28; p=0.0014) and MACE (HR: 1.12; p=0.049) but lower risk of MALE (HR: 0.82; p<0.0001) and vascular reintervention (HR: 0.77; p<0.0001) than endobypass patients. Mean costs were consistently lower for endobypass patients. The cumulative length of hospital stay was lower in endobypass than in OS patients (mean 34.5 vs 39.0 days). The 90-day “days alive and out of hospital” rate was similar in both groups: 85.6 vs 85.1 days, respectively.
CONCLUSIONS: Endovascular treatment involving dedicated covered vascular endoprostheses appears to be an effective strategy for reducing major amputation rates and National Health Insurance costs.
METHODS: This retrospective, population-based study used the French National Health Data System. Patients with LLPAD hospitalized between January 2018 and December 2022 were identified from a combination of diagnosis, procedure codes and endoprosthesis types. We conducted a 1:3 case-control study by matching patients treated with endobypass with those undergoing OS, using a propensity score incorporating demographic data, disease severity and clinical characteristics to ensure baseline comparability. Outcomes of interest were death, myocardial infarction, stroke, major amputation, major adverse cardiovascular events (MACE; first occurrence of mortality, stroke or myocardial infarction), major adverse limb events (MALE; first occurrence of major amputation or vascular reintervention) and vascular reinterventions. Costs were calculated from the National Health Insurance perspective.
RESULTS: The matched cohort comprised 2,246 and 6,738 patients undergoing endobypass and OS, respectively. Risk of death (hazard ratio [HR]: 1.11; p=0.1335), myocardial infarction (HR: 1.15; p=0.1719) and stroke (HR: 1.05; p=0.6248) were similar between the groups. OS patients were at higher risk of major amputation (HR: 1.28; p=0.0014) and MACE (HR: 1.12; p=0.049) but lower risk of MALE (HR: 0.82; p<0.0001) and vascular reintervention (HR: 0.77; p<0.0001) than endobypass patients. Mean costs were consistently lower for endobypass patients. The cumulative length of hospital stay was lower in endobypass than in OS patients (mean 34.5 vs 39.0 days). The 90-day “days alive and out of hospital” rate was similar in both groups: 85.6 vs 85.1 days, respectively.
CONCLUSIONS: Endovascular treatment involving dedicated covered vascular endoprostheses appears to be an effective strategy for reducing major amputation rates and National Health Insurance costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD40
Topic
Clinical Outcomes, Economic Evaluation, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Surgery