Original Title: Coste-efectividad del tratamiento endovascular frente a cirugía abierta en pacientes con enfermedad esteno-oclusiva de la arteria femoral

Authors' objectives: The purpose of this report is to respond to a request from the General Secretariat of the Spanish Ministry of Health and Social Policy about the efficiency of three treatment alternatives of femoral stenosis to reduce/delay the rate of amputation and/or death. These alternative therapies include bypass surgery (BPS), percutaneous transluminal angioplasty with selective stent insertion (PTA/S) and percutaneous transluminal angioplasty with selective stent insertion might be followed by bypass surgery reintervention (PTA/S/CBP).

Authors' results and conclusions: RESULTS: The average total cost of the alternative PTA/S for the 30 years time horizon is € 24,581 and the average effectiveness of 6.857 QALYs. This alternative is more expensive on average, while taking in account both the small difference between the results as the great variability in the costs of alternatives, these results are not conclusive. In terms of effectiveness something similar happens and it is not possible to conclude that the alternative of PTA/S is less effective. The average total cost of the alternative simulations for PTA/S/BPS is € 18,351, for which, a priori, seems to be the least costly of the alternatives under study. On the other hand, the average overall effectiveness of simulations is 7.049 QALYs, showing, on average, greater effectiveness than that of PTA/S but lower than that of BPS. The results of BPS are € 24,056 and 7.281 QALYs for cost and effectiveness respectively. The alternatives PTA/S/BPS and BPS show higher probabilities to be efficient alternatives. For a willingness to pay lower than € 40,000 / QALY the alternative most likely to be more efficient is the PTA/S/BPS alternative. For a willingness to pay higher than € 40,000 / QALY, the CBP is the most likely to be more efficient. If the willingness to pay is € 30,000 / QALY, the opportunity cost would be lost by introducing PTA/S/BPS exceeds € 15,000 per patient treated. CONCLUSIONS: The effectiveness results of the three therapeutic strategies, identifies the PTA/S/BPS as the most efficient for a willingness to pay lower than € 40,000 / QALY. However, the probability of correct decision is only 50%. This situation, taking in account the high opportunity costs, suggests the needed of new clinical trials or observational studies in our environment that will help to remove the uncertainty about the results.

Authors' methods: To meet the objective to analyze the cost-effectiveness, it was decided to perform an economic evaluation, by implementing a Markov model with three main branches representing each strategies studied. In each branch, all possible health states, for a patient with chronic obstructive disease could walk, was represented. Inclusion criteria of patients in this study were: patients 60 years of age suffering intermittent claudication unable to walk more than 100 metres, which is able to receive both BPS and PTA/S. We decided to use the perspective of the National Health System (SNS) and a time horizon of 30 years at discounts of 3% for costs and effects. The effectiveness measure was quality-adjusted life years. We performed a multivariate probabilistic sensitivity analysis by means of Monte Carlo 2nd order simulation. Acceptability curves and the expected value of perfect information were calculated.

Project Status: Completed

Year Published: 2010

URL for published report: https://sescs.es/coste-efectividad-del-tratamiento-endovascular-frente-a-cirugia-abierta-en-la-femoral/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es