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Objective <p>To assess the cost effectiveness of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) versus kissing stents (KS) and open surgical repair (OSR) for treating extensive aorto-iliac occlusive disease (AIOD).</p> Methods <p>A decision tree followed by a health state transition model was developed to simulate changes in Rutherford status and the occurrence of reinterventions, amputation, and death. A Dutch health care perspective and a five-year time horizon were used. Model inputs were estimated using non-randomised data of individuals who underwent a CERAB or a KS procedure and literature. The total number of reinterventions, life years, quality-adjusted life years (QALYs) and health care costs per strategy were calculated as well as the incremental costs and QALYs between strategies, and corresponding incremental cost-effectiveness ratios (ICERs).</p> Results <p>OSR resulted in the lowest survival due to a higher peri-operative probability of death. OSR resulted in a lower probability of reinterventions (6%, 95% Confidence Interval (CI): 1-15%) than CERAB (17%, 95%CI: 11-27%) and KS (29%, 95%CI: 17-46%). CERAB dominated OSR since it led to 0.032 (95%CI: -0.038-0.082) incremental QALYs and €-11,466 (95%CI: €-18,934-€-3,415) incremental costs versus OSR. CERAB led to 0.048 (95%CI: 0.011–0.109) incremental QALYs, €5,324 (95%CI: €2,938-€10,397) incremental costs, and an ICER of €110,201 per QALY versus KS.</p> Conclusions <p>CERAB dominated OSR and resulted in the highest health benefits and costs but does not seem to be cost effective versus KS for treating AIOD. Performing a randomised comparison of these treatment modalities is essential to confirm these findings.</p>

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Cost-effectiveness analysis of the covered endovascular reconstruction of the aortic bifurcation versus kissing stents and open surgical repair for the treatment of aorto-iliac occlusive disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月30日

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  • Xavier G. L. V. Pouwels,
  • Suzanne Holewijn,
  • Daphne van der Veen,
  • Mauricio Gonzalez-Urquijo,
  • Michel M. P. J. Reijnen,
  • Hendrik Koffijberg

摘要

Objective

To assess the cost effectiveness of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) versus kissing stents (KS) and open surgical repair (OSR) for treating extensive aorto-iliac occlusive disease (AIOD).

Methods

A decision tree followed by a health state transition model was developed to simulate changes in Rutherford status and the occurrence of reinterventions, amputation, and death. A Dutch health care perspective and a five-year time horizon were used. Model inputs were estimated using non-randomised data of individuals who underwent a CERAB or a KS procedure and literature. The total number of reinterventions, life years, quality-adjusted life years (QALYs) and health care costs per strategy were calculated as well as the incremental costs and QALYs between strategies, and corresponding incremental cost-effectiveness ratios (ICERs).

Results

OSR resulted in the lowest survival due to a higher peri-operative probability of death. OSR resulted in a lower probability of reinterventions (6%, 95% Confidence Interval (CI): 1-15%) than CERAB (17%, 95%CI: 11-27%) and KS (29%, 95%CI: 17-46%). CERAB dominated OSR since it led to 0.032 (95%CI: -0.038-0.082) incremental QALYs and €-11,466 (95%CI: €-18,934-€-3,415) incremental costs versus OSR. CERAB led to 0.048 (95%CI: 0.011–0.109) incremental QALYs, €5,324 (95%CI: €2,938-€10,397) incremental costs, and an ICER of €110,201 per QALY versus KS.

Conclusions

CERAB dominated OSR and resulted in the highest health benefits and costs but does not seem to be cost effective versus KS for treating AIOD. Performing a randomised comparison of these treatment modalities is essential to confirm these findings.