Greenberg Dan, Rosenfield Kenneth, Garcia Lawrence A, Berezin Ronna H, Lavelle Tara, Fogleman Stanley, Cohen David J
Cardiovascular Division, Beth Israel-Deaconess Medical Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Vasc Interv Radiol. 2004 Oct;15(10):1065-9. doi: 10.1097/01.RVI.0000136293.18041.88.
Although several prospective studies have examined the safety and efficacy of stent placement for femoropopliteal arterial disease, the current cost of these procedures is unknown. To estimate and compare hospital costs associated with conventional balloon angioplasty (percutaneous transluminal angioplasty [PTA]) and stent placement for patients with symptomatic peripheral arterial disease, the authors performed a prospective economic evaluation in conjunction with the Intracoil Femoropopliteal Stent Trial (VascuCoil).
Between May 1997 and December 1999, 266 patients with stenotic or occluded superficial femoral or popliteal arteries were prospectively randomized to treatment with the IntraCoil stent or PTA. Detailed resource use and cost data for each patient's initial revascularization procedure and ensuing hospitalization were collected and analyzed on an intention-to-treat basis.
Compared with conventional balloon angioplasty, stent placement did not improve clinical outcomes but increased procedure duration, equipment costs, and physician services. As a result, initial hospital costs were approximately 3,500 dollars higher for patients randomized to the IntraCoil stent, compared with PTA (8,435 dollars vs 4,980 dollars; P < .001).
As performed in the VascuCoil trial, primary stent placement for femoropopliteal disease did not improve clinical outcomes but increased initial treatment costs by more than 3,000 dollars. Because there were no substantial differences in subsequent clinical outcomes between the two treatments, it is unlikely that these increased initial costs would be offset by savings in follow-up costs. These findings suggest that a strategy of routine stent implantation for patients undergoing femoropopliteal PTA is not optimal on economic grounds and that PTA with provisional stent implantation is preferred.
尽管有多项前瞻性研究探讨了股腘动脉疾病支架置入术的安全性和有效性，但目前这些手术的费用尚不清楚。为了估计和比较有症状的外周动脉疾病患者接受传统球囊血管成形术（经皮腔内血管成形术[PTA]）和支架置入术的住院费用，作者结合Intracoil股腘动脉支架试验（VascuCoil）进行了一项前瞻性经济评估。
1997年5月至1999年12月期间，266例股浅动脉或腘动脉狭窄或闭塞的患者被前瞻性随机分为接受IntraCoil支架治疗或PTA治疗。收集并分析了每位患者初次血运重建手术及随后住院期间的详细资源使用情况和费用数据，并采用意向性分析方法。
与传统球囊血管成形术相比，支架置入术虽未改善临床结局，但增加了手术时间、设备成本和医生服务费用。因此，随机接受IntraCoil支架治疗的患者初始住院费用比接受PTA治疗的患者高出约3500美元（8435美元对4980美元；P <.001）。
如在VascuCoil试验中所进行的那样，股腘动脉疾病的初次支架置入术并未改善临床结局，但初始治疗费用增加了3000多美元。由于两种治疗方法在后续临床结局方面没有实质性差异，这些增加的初始费用不太可能通过后续费用的节省来抵消。这些研究结果表明，从经济角度来看，对接受股腘动脉PTA的患者采用常规支架植入策略并非最佳选择，临时支架植入的PTA更为可取。
