Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study

Eur J Vasc Endovasc Surg. 2024 Jul;68(1):100-107. doi: 10.1016/j.ejvs.2024.02.001. Epub 2024 Feb 7.

Abstract

Objective: To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective.

Methods: European multicentre study involving consecutive patients requiring femoropopliteal TLR (January 2017 - December 2021). The primary outcome was overall cost (euros) associated with a TLR procedure from presentation to discharge. Exact costs per constituent, clinical characteristics, and early outcomes were reported.

Results: This study included 482 TLR procedures (retrospectively, 13 hospitals, six countries): 56% were female, mean age was 75 ± 2 years, 61% were Rutherford class 5 or 6, 67% had Tosaka class 3 disease, and 16% had common femoral or iliac involvement. A total of 52% were hybrid procedures and 6% involved open surgery only. Technical success was 70%, 30 day mortality rate was 1%, and the 30 day major amputation rate was 4%. Most costs were for operating time during the TLR (healthcare professionals' salaries, indirect and estate costs), with a mean of: €21 917 ± €2 110 for all procedures; €23 337 ± €8 920 for open procedures; €12 903 ± €3 108 for endovascular procedures; and €22 806 ± €3 977 for hybrid procedures. In a regression analysis, procedure duration was the main parameter associated with higher overall TLR costs (coefficient, 2.77; standard error, 0.88; p < .001). The mean cost per operating minute of TLR (indirect, estate costs, all salaried staff present included) was €177 and the mean cost per night stay in hospital (outside intensive care unit) was €356. The mean cost per overnight intensive care unit stay (minimum of 8 hours per night) was €1 193.

Conclusion: The main driver of the considerable peri-procedure costs associated with femoropopliteal TLR was procedure time.

Keywords: Cost effectiveness; Peripheral artery disease; Revascularisation.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Constriction, Pathologic / economics
  • Cost-Benefit Analysis
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / economics
  • Endovascular Procedures* / instrumentation
  • Europe
  • Female
  • Femoral Artery* / surgery
  • Hospital Costs / statistics & numerical data
  • Humans
  • Male
  • Peripheral Arterial Disease* / economics
  • Peripheral Arterial Disease* / mortality
  • Peripheral Arterial Disease* / surgery
  • Peripheral Arterial Disease* / therapy
  • Popliteal Artery* / surgery
  • Retrospective Studies
  • Stents* / economics
  • Treatment Outcome