OBJECTIVES:

Hemodialysis patients with an arteriovenous graft (AVG) implant can experience AVG stenosis and thrombosis which require further procedural revision to maintain an open circuit for hemodialysis. This analysis aims to establish the economic value of revising an AVG with a covered stent graft compared to percutaneous balloon angioplasty (PTA) using clinical and resource use data from the Gore REVISE Clinical Study along with cost data specific to German treatment setting.

METHODS:

The REVISE Study (NCT00737672) was a prospective, multicentre, randomised controlled trial comparing the GORE^® VIABAHN^® Endoprosthesis with PROPATEN Bioactive Surface (N=131) versus PTA (N=138) for treatment of dysfunctional or thrombosed prosthetic AVGs and followed patients for two years. The trial collected resource utilization data used in this economic analysis, including the number of devices used and types of repeat interventions. Procedure cost data is from the 2021 German DRG rates. The 2022 list prices are used for the GORE^® VIABAHN^® Device, prices for other stent grafts used in repeat interventions are from a 2021 German Peripheral Vascular devices market report (© 2021 Decision Resource Group, Inc.).

RESULTS:

Patients in the stent graft arm incurred average total costs (ATCs) per patient of €18,927 at two years compared to €20,112 in the PTA arm, showing savings of €1,185. ATCs include index procedure costs, where stent graft patients had higher procedure and device costs compared to PTA (€3,114), but average repeat intervention costs (ARICs) over 24 months were lower than the PTA arm by €4,299, making up for the index cost difference.

CONCLUSIONS:

Treating dysfunctional and thrombosed AVGs with a stent graft is shown to have an economic benefit for the German healthcare system compared to PTA in addition to clinical benefit as demonstrated in the REVISE Study.