TRENDS IN UTILIZATION OF ENDOVASCULAR ARTERIAL REVASCULARIZATION MODALITIES BELOW THE KNEE IN GERMANY 2009-16
Author(s)
Geisler BP1, Weber SA2, Pietzsch M3, Pietzsch JB1, Zeller T4
1Wing Tech Inc., Menlo Park, CA, USA, 2Cellogic GmbH, Berlin, Germany, 3Wingtec GmbH, Karlsruhe, Germany, 4Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
OBJECTIVES : Endovascular revascularization of below the knee (BTK) arterial lesions provide new treatment opportunities for a challenging clinical need. Especially drug-eluting therapies have demonstrated improved vessel patency and reduced revascularization rates. The German healthcare system has historically been an early adopter of new interventional techniques. The objective was to study adoption and utilization patterns. METHODS : Therapy-specific procedure volumes for the 8-year period from 2009-16 were obtained from the German Federal Statistics Office for plain old balloon angioplasty (POBA), bare metal stenting (BMS), drug-eluting stenting (DES), drug-coated balloon angioplasty (DCB), and atherectomy as well as for bypass surgery and amputations. Trends were analyzed via Cuzick’s test. RESULTS : Bypass surgery showed no clear trend over time (p=0.45) with a procedure volume of around, 2,300 to 3,100 per year. Even though there was no clear trend over time (p=0.49), the number of endovascular procedures declined by 30% from 24,915 to 15,261. While POBA declined by more than half from 21,500 to 8,426 (-53%) without a clear trend over time (p=0.31), and BMS was slightly increased from 2,564 to 3,271 (+8%) with a borderline trend (p=0.05), DES, and atherectomy increased from 379 to 2,254, and from 472 to 1,310 (+386%, and 163%) with clear trends over time (p=0.01). DCB for all non-coronary vessels increased from 4,562 to 35,940 (+212%, p=0.01). Total amputations remained around 62,000 to 62,300, but major amputations decreased (p<0.01) from 22,648 to 17,991 and minor amputations increased from 40.910 to 44,400 (p=0.04). CONCLUSIONS : DES, DCB, and atherectomy are the only PAD-BTK modalities whose volume clearly grew over the last eight years in Germany. This shift in modalities and the expected lower need for repeat procedures might have contributed to the observed reduction in POBA volumes and a shift from major to minor amputations.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PMD107
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders