A recent budget impact model of endovascular interventions in the USA and Germany found not only that drug-eluting balloons are a cost-effective therapy, but also that at current reimbursement rates, payer economics are in conflict with provider economics.
Thomas Zeller, University Heart-Center Freiburg, Bad Krozingen, Germany, told delegates at LINC that drug-eluting balloons may be cost-effective through prevention of target lesion revascularisation at one year of follow-up. “Financial incentives to improve drug-eluting balloon reimbursements may help lower total healthcare costs,” Zeller said.
Zeller told Vascular News: “Despite the initially slightly higher costs to the payer for the index procedure for drug-eluting balloon compared to plain old balloon angioplasty, overall costs during a two-year period are cheaper due to lower reintervention rates resulting in less re-hospitalisations. On the other hand, the provider (hospital) loses money due to less frequent re-hospitalisations /re-do procedures if a treatment is more successful (as in the case of drug-eluting balloons).”
The study found that drug-eluting balloons were the least costly strategy for payers: 21% and 26% lower costs than drug-eluting stents and bare metal stents respectively. The study also found that switching even 50% of current angioplasty cases from percutaneous transluminal angioplasty to a drug-eluting balloon strategy could lead to an annual cost reduction of US$250 million to US Medicare.
Similarly, an economic assessment of drug-eluting balloon vs. percutaneous transluminal angioplasty in a Swiss University Hospital found that over a one-year period percutaneous transluminal angioplasty cost around 90,000 Swiss francs more than drug-eluting balloon therapy due to repeat intervention costs, despite the greater initial acquisition costs associated with drug-eluting balloons. And yet, percutaneous transluminal angioplasty reimbursement is approximately 154,000 Swiss francs more than for drug-eluting balloons from the physician/facility provider perspective.
Zeller explained that there were certain limitations with the study results, including that there is a scarce amount of comparative data available, especially those of high quality such as randomised controlled trials. He also noted that target lesion revascularisation rates vary highly between trials as do the study designs and populations.
“In this study we have assumed a constant target lesion revascularisation hazard rate and the model only includes up to one potential revascularisation post the index procedure. The quality of life/functional outcomes were not considered and some of the 24-month data is predictive and not based upon actual results,” Zeller clarified.