Cost-Effectiveness of Drug-Coated Balloon Angioplasty Compared With Conventional Balloon Angioplasty for Arteriovenous Access Flow Dysfunction.
arteriovenous access
cost effectiveness analysis
drug coated balloon
end stage renal disease
Journal
Value in health regional issues
ISSN: 2212-1102
Titre abrégé: Value Health Reg Issues
Pays: United States
ID NLM: 101592642
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
28
07
2021
revised:
26
03
2022
accepted:
12
05
2022
pubmed:
1
7
2022
medline:
20
9
2022
entrez:
30
6
2022
Statut:
ppublish
Résumé
This study aimed to determine the cost-effectiveness of drug-coated balloon (DCB) angioplasty compared with conventional balloon angioplasty (cPTA) in patients with arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) dysfunction from a Singapore healthcare perspective. Existing cost-effectiveness studies comparing DCB and cPTA have not incorporated AVF/AVG abandonment costs. This Markov model-based economic evaluation incorporated AVF/AVG creation and maturation costs on top of routine intervention costs to model a hypothetical cohort of 60-year-old AVF/AVG flow dysfunction patients. Effectiveness was measured in quality-adjusted life-years. Cost-effectiveness was assessed using incremental net monetary benefit (NMB) at a Singapore willingness-to-pay threshold of Singapore dollar (S$)87 000. Deterministic and probabilistic sensitivity analyses were performed to examine parameter uncertainty. To test hypotheses regarding cost-effectiveness, intervention counts per patient, cumulative incidence functions of AVF/AVG abandonment, and survival curves of death were compared between DCB and cPTA. DCB was not cost-effective at 3-year horizon (NMB = -S$1424), but was cost-effective at 1- and 6-year horizons (NMB = S$356 and S$3738, respectively). At 3 years, there was a 34.5% probability of DCB being cost-effective, but at 1- and 6-year horizons there was, respectively, 58.6% and 59.9% probability of DCB being cost-effective. DCB had graphically less AVF/AVG-abandonments, but this was not statistically significant (P = .21). Differences in other parameters were neither graphically nor statistically significant. With AVF/AVG abandonment considered, DCB may be weakly cost-effective compared with cPTA in treating AVF/AVG flow dysfunction. AV access creation and maturation costs could have important explanatory value in assessing DCB cost-effectiveness.
Identifiants
pubmed: 35772197
pii: S2212-1099(22)00117-0
doi: 10.1016/j.vhri.2022.05.002
pii:
doi:
Substances chimiques
Ethylamines
0
2-(4-chlorophenylthio)triethylamine
14214-33-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
155-162Informations de copyright
Copyright © 2022 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.