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

• Published in: European journal of vascular and endovascular surgery 2024-07, Vol.68 (1), p.100-107
• Main Authors: Saratzis, Athanasios, Torsello, Giovanni B., Cardona-Gloria, Yamel, Van Herzeele, Isabelle, Messeder, Sarah J., Zayed, Hany, Torsello, Giovanni F., Chisci, Emiliano, Isernia, Giacomo, D'Oria, Mario, Stavroulakis, Konstantinos, Uijtterhaeghen, Gilles, e Melo, Ryan Gouveia, Gianluigi, Fino, Fazzini, Stefano, Coscas, Raphael, Valdivia, Andrés Reyes, Gordillo, Sergio, Patel, Bhavisha, Lepidi, Sandro, Guerra Requena, Mercedes, Tsilimparis, Nikolaos, Konstantinou, Nikolaos, Troisi, Nicola
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Constriction, Pathologic - economics; Cost effectiveness; 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; Peripheral artery disease; Popliteal Artery - surgery; Retrospective Studies; Revascularisation; Stents - economics; Treatment Outcome
• ISSN: 1078-5884; 1532-2165; 1532-2165
• DOI: 10.1016/j.ejvs.2024.02.001

To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer’s perspective. 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. 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. The main driver of the considerable peri-procedure costs associated with femoropopliteal TLR was procedure time.