1. Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study.
- Author
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Saratzis A, Torsello GB, Cardona-Gloria Y, Van Herzeele I, Messeder SJ, Zayed H, Torsello GF, Chisci E, Isernia G, D'Oria M, and Stavroulakis K
- Subjects
- Humans, Female, Aged, Male, Retrospective Studies, Europe, Cost-Benefit Analysis, Treatment Outcome, Aged, 80 and over, Hospital Costs statistics & numerical data, Constriction, Pathologic economics, Peripheral Arterial Disease economics, Peripheral Arterial Disease surgery, Peripheral Arterial Disease therapy, Peripheral Arterial Disease mortality, Femoral Artery surgery, Popliteal Artery surgery, Endovascular Procedures economics, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Stents economics
- 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., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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