Duke NUS Medical School, Singapore.
Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
Value Health Reg Issues. 2022 Sep;31:155-162. doi: 10.1016/j.vhri.2022.05.002. Epub 2022 Jun 27.
This study aimed to determine the cost-effectiveness of drug-coated balloon (DCB) angioplasty compared with conventional balloon angioplasty (cPTA) in patients with arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) dysfunction from a Singapore healthcare perspective.
Existing cost-effectiveness studies comparing DCB and cPTA have not incorporated AVF/AVG abandonment costs. This Markov model-based economic evaluation incorporated AVF/AVG creation and maturation costs on top of routine intervention costs to model a hypothetical cohort of 60-year-old AVF/AVG flow dysfunction patients. Effectiveness was measured in quality-adjusted life-years. Cost-effectiveness was assessed using incremental net monetary benefit (NMB) at a Singapore willingness-to-pay threshold of Singapore dollar (S$)87 000. Deterministic and probabilistic sensitivity analyses were performed to examine parameter uncertainty. To test hypotheses regarding cost-effectiveness, intervention counts per patient, cumulative incidence functions of AVF/AVG abandonment, and survival curves of death were compared between DCB and cPTA.
DCB was not cost-effective at 3-year horizon (NMB = -S$1424), but was cost-effective at 1- and 6-year horizons (NMB = S$356 and S$3738, respectively). At 3 years, there was a 34.5% probability of DCB being cost-effective, but at 1- and 6-year horizons there was, respectively, 58.6% and 59.9% probability of DCB being cost-effective. DCB had graphically less AVF/AVG-abandonments, but this was not statistically significant (P = .21). Differences in other parameters were neither graphically nor statistically significant.
With AVF/AVG abandonment considered, DCB may be weakly cost-effective compared with cPTA in treating AVF/AVG flow dysfunction. AV access creation and maturation costs could have important explanatory value in assessing DCB cost-effectiveness.
本研究旨在从新加坡医疗保健的角度出发，确定药物涂层球囊（DCB）血管成形术与传统球囊血管成形术（cPTA）治疗动静脉瘘（AVF）和动静脉移植物（AVG）功能障碍患者的成本效益。
现有的比较 DCB 和 cPTA 的成本效益研究尚未纳入 AVF/AVG 废弃成本。本基于马尔可夫模型的经济评估在常规干预成本的基础上纳入了 AVF/AVG 建立和成熟成本，以构建一个 60 岁 AVF/AVG 流量功能障碍患者的假设队列。使用质量调整生命年来衡量疗效。使用新加坡愿意支付的 87000 新加坡元（S$）的阈值下的增量净货币收益（NMB）来评估成本效益。进行了确定性和概率敏感性分析以检查参数不确定性。为了检验成本效益的假设，比较了 DCB 和 cPTA 之间每个患者的干预次数、AVF/AVG 废弃的累积发生率函数和死亡的生存曲线。
在 3 年的时间内，DCB 不具有成本效益（NMB = -S$1424），但在 1 年和 6 年的时间内具有成本效益（NMB = S$356 和 S$3738）。在 3 年内，DCB 具有 34.5%的成本效益概率，但在 1 年和 6 年内，DCB 分别具有 58.6%和 59.9%的成本效益概率。DCB 的 AVF/AVG 废弃率较低，但这在统计学上并不显著（P =.21）。其他参数的差异在图形上和统计学上均不显著。
考虑到 AVF/AVG 的废弃，与 cPTA 相比，DCB 可能在治疗 AVF/AVG 流量功能障碍方面具有微弱的成本效益。AV 接入的建立和成熟成本在评估 DCB 的成本效益方面可能具有重要的解释价值。
