COST-CONSEQUENCE ANALYSIS OF COVERED BALLOON-EXPANDABLE STENTS WITH PUBLISHED 3-YEAR OUTCOMES FOR AORTOILIAC OCCLUSIVE DISEASE IN THE UK
Author(s)
Kashfa Iqbal1, Lewis Meecham, MD FRCS2, Ashish Patel Patel, PhD FRCS3, Julie Lyon, BSc4.
1EMEA HEOR, W.L. Gore & Associates, 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, W.L. Gore & Associates, 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 hospital 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 published systematic literature review. The comparators were selected based on available 3-year published outcome data. 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 the deterministic sensitivity analyses(±20%), including 36-month fTLR rates, amputation rates and device costs.
RESULTS: CBES 1 entailed higher device acquisition costs versus CBES 2 and CBES 3 (£2,914 vs £798 and £1,472 per patient) but lower downstream costs. TLR-related costs were reduced (£982 vs £1,964 and £2,160) and amputation costs were minimal (£24 vs £222 and £747), resulting in total per-patient costs of £3,920 for CBES 1 versus £4,303 and £4,379 for CBES 2 and CBES 3 (incremental cost: −£383 and -£459). Cost differences were driven by lower reintervention rates (0.08 vs 0.16 and 0.18 TLR events per patient). At the 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 published systematic literature review. The comparators were selected based on available 3-year published outcome data. 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 the deterministic sensitivity analyses(±20%), including 36-month fTLR rates, amputation rates and device costs.
RESULTS: CBES 1 entailed higher device acquisition costs versus CBES 2 and CBES 3 (£2,914 vs £798 and £1,472 per patient) but lower downstream costs. TLR-related costs were reduced (£982 vs £1,964 and £2,160) and amputation costs were minimal (£24 vs £222 and £747), resulting in total per-patient costs of £3,920 for CBES 1 versus £4,303 and £4,379 for CBES 2 and CBES 3 (incremental cost: −£383 and -£459). Cost differences were driven by lower reintervention rates (0.08 vs 0.16 and 0.18 TLR events per patient). At the 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
EE466
Topic
Economic Evaluation, Medical Technologies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas