The Supera peripheral stent offers the lowest risk of repeat procedures and is an “economically attractive” treatment for both payer and provider, according to a cost-effectiveness analysis presented at the 2015 VIVA meeting (2–5 November, Las Vegas, USA). The data were presented by Brian DeRubertis, University of California Los Angeles, USA.
DeRubertis told delegates that from a payer (Medicare) perspective, Supera is a cost-saving strategy compared to angioplasty, bare metal stenting, drug-eluting stents and drug-coated balloons, while for providers Supera offers the greatest remaining payment per procedure.
“As new technology for treating arterial occlusive disease becomes available, as clinicians we find ourselves trying to apply quality care to our patients in a cost-effective fashion,” DeRubertis said. It was this interplay between cost and quality that was the focus of DeRubertis’ presentation.
DeRubertis explained that the rate of target lesion revascularisation is impacted by the initial choice of endovascular strategy. The economic implications of this initial choice are affected by procedure costs, associated target lesion revascularisation risk and the costs associated with repeat revascularisation procedures.
The Supera peripheral stent treats patients with blocked blood vessels in the upper leg caused by peripheral artery disease. Supera has been shown to be clinically effective through the SUPERB trial, which demonstrated sustained freedom from target lesion revascularisation over a three-year period. However, “less is known about the economic impact of this modality compared with other treatment strategies,” commented DeRubertis.
DeRubertis and colleagues evaluated five different endovascular strategies (percutaneous transluminal angioplasty, bare metal stent, drug-eluting stent, drug-coated balloon and the Supera interwoven nitinol stent). The researchers used the risk of target lesion revascularisation to estimate the expected number of reinterventions per patient for each strategy. Target lesion revascularisation rates were determined using past US investigational device exemption studies, chosen to ensure high-quality data with consistent trial methodology and to decrease “some of the heterogeneity between lesion characteristics and patient population”.
Using these studies, the researchers calculated pooled three-year target lesion revascularisation rates. The pooled rate for angioplasty was 46.4%, bare metal stent 29.2%, drug-eluting stent 19.4%, drug-coated balloon 24.6% and Supera 6%.
One of the most important points in the baseline characteristics of patients across the pooled studies was that lesion lengths were all “relatively short”, ranging from 66–83mm. This was not the case for rates of severe calcification, which was present in as few as 9% of drug-coated balloon patients and as many as 45% of Supera patients.
Per 100 patients over three years, those treated with angioplasty were predicted to have the highest number of repeat procedures (53) with around 50% of these patients undergoing target lesion revascularisation. The lowest number of repeat procedures (7) was seen in the Supera group. This data is “important from a patient perspective” said DeRubertis as it shows how different modalities have different risks of reintervention and other complications.
From the payer perspective (cost to Medicare facility and physician reimbursement) over three years, the costs per patient ranged from the highest with bare metal stenting (US$16,158) to the lowest with the Supera stent (US$13,036). The differences, DeRubertis said, were “largely driven” by the differing risks of target lesion revascularisation and repeat interventions between the different modalities. DeRubertis also told the audience that Supera is a cost-saving method when compared to the other four treatment modalities, and was most cost effective when compared with angioplasty and bare metal stenting.
Looking at costs from a provider perspective (hospital remaining payment) over three years, DeRubertis said that although treatments such as angioplasty result in higher value total hospital remaining payment (US$1.31m per 100 patients), “this comes at the expense of the patient, who is undergoing a 50% increased risk of reinterventions”. To correct for this and to identify the true value of treatment, the researchers divided the hospital remaining patients by the number of procedures to calculate an average remaining payment procedure. These figures showed that Supera was actually the most profitable for the provider (US$9,926) and offered patients the least chance of reintervention, with the drug-coated balloon as the least profitable (US$8,442).