Department of Radiology, The Catholic University of Korea, Seoul, South Korea.
Wing Tech Inc., Menlo Park, California, USA.
Nephrology (Carlton). 2022 Nov;27(11):859-868. doi: 10.1111/nep.14085. Epub 2022 Sep 6.
The recent IN.PACT AV Access study found drug-coated balloon therapy to be associated with reduced reinterventions compared to percutaneous transluminal angioplasty using standard balloons in the management of arteriovenous fistula stenosis. The economic implications of drug-coated balloon use in Asia, including Japan and Korea, remain unknown.
A decision-analytic model was developed to calculate strategy-specific costs for Korea and Japan through 5-year follow-up. The analysis assumed maintained therapy benefit beyond current trial follow-up of 1 year in the base case, with several alternative scenarios explored in sensitivity analysis. Costs were derived from claims and reimbursement data, and projections were evaluated at 3 and 5 years post-index procedure.
Model-projected access circuit reintervention events for drug-coated versus standard balloons were 1.70 versus 2.76 (-1.06) and 2.53 versus 4.10 (-1.57) at 3 and 5 years in the base case. Corresponding 3- and 5-year costs were ₩6 211 103 versus ₩7 605 553 (-₩1 394 451) and ₩7 766 051 versus ₩10 124 954 (-₩2 358 904) in Korea, and ¥1 469 824 versus ¥1 504 161 (-¥34 337) and ¥1 956 931 versus ¥2 106 632 (-¥149 701) in Japan. In scenario analyses, drug-coated balloons remained cost saving at 3- and 5-year follow-up in Korea, but required up to 5 years to reach cost-savings in Japan. Drug-coated balloon use in reinterventions increased projected savings, as did younger treatment age.
Treatment of arteriovenous fistulas with the IN.PACT AV drug-coated balloon, based on preliminary data, may lead to meaningful reductions in reintervention costs that would render it cost-saving at timeframes of around 1 year in Korea and between 3 and 5 years in Japan.
最近的 IN.PACT AV 血管接入研究发现，与使用标准球囊经皮腔内血管成形术相比，药物涂层球囊治疗与降低动静脉瘘狭窄的再介入相关。在亚洲（包括日本和韩国），药物涂层球囊的使用的经济意义尚不清楚。
通过 5 年随访，建立了一个决策分析模型，以计算韩国和日本的特定策略成本。在基础案例中，假设在当前试验随访 1 年的基础上，治疗效果保持，在敏感性分析中探讨了几种替代方案。成本来自索赔和报销数据，在索引手术后 3 年和 5 年进行预测。
在基础案例中，药物涂层球囊与标准球囊相比，预计在 3 年和 5 年时，血管接入回路再介入事件分别为 1.70 次和 2.76 次（-1.06 次）和 2.53 次和 4.10 次（-1.57 次）。在韩国，相应的 3 年和 5 年成本分别为₩6211103 和₩7766051（-₩1394451）和₩7605533 和₩10124954（-₩2358904）；在日本，相应的 3 年和 5 年成本分别为¥1469824 和¥1956931（-¥34337）和¥1504161 和¥2106632（-¥149701）。在情景分析中，在韩国，药物涂层球囊在 3 年和 5 年的随访中仍然具有成本效益，但在日本需要 5 年时间才能达到成本节约。动静脉瘘再介入治疗中使用药物涂层球囊增加了预计的节省，治疗年龄越年轻，节省效果越大。
基于初步数据，使用 IN.PACT AV 药物涂层球囊治疗动静脉瘘可能会显著降低再介入成本，在韩国，其成本效益约为 1 年，在日本，约为 3 年至 5 年。
