Purpose

Improvement in long-term outcomes through innovative, cost-effective medical technologies is a focus for endovascular procedures aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). The advent of drug-eluting stents (DES) has improved symptomatic PAD treatment via a reduction in high rates of target lesion revascularisation (TLR). The present study aimed to compare the 5-year financial impact of treatment with Eluvia, a new paclitaxel-eluting stent, versus treatment with Zilver PTX, a drug-coated stent, among patients in Australia by developing a budget impact model (BIM).

Methods

A BIM was developed from an Australian public hospital payer perspective using Australian national cost weights (AUD), published literature, and public hospital audit data. Clinical outcomes, including clinically driven TLRs (CD-TLRs), adverse events, and length of stay, were based on the 2-year results of the IMPERIAL trial, which compared Eluvia DES to Zilver PTX.

Results

Assuming EVP eligibility rate of 80% and DES uses rate ranging from 10 to 28% (superficial femoral artery lesions only), the 5-year model forecasted a treatment population between 14,428 and 40,399 patients. The model estimated 1499–4198 fewer CD-TLRs and 16,515–46,243 fewer hospital days with Eluvia DES use. This translated to 5-year potential savings of $4.3–$12.1 million to the Australian public hospital payer attributable to reduced CD-TLRs for Eluvia DES and $33.1–$92.6 million to Australian public hospitals owing to reduced adverse events and hospital bed days.

Conclusion

Eluvia DES use as treatment for symptomatic lower-limb PAD could lead to potential savings for the Australian public healthcare system based on improved patient outcomes.

中文翻译：

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有症状的下肢外周动脉疾病患者使用药物洗脱支架的预算影响模型：澳大利亚的观点

目的

通过创新、具有成本效益的医疗技术改善长期结果是旨在治疗症状性下肢外周动脉疾病 (PAD) 的血管内手术的重点。药物洗脱支架 (DES) 的出现通过降低靶病变血运重建 (TLR) 的高发生率来改善症状性 PAD 治疗。本研究旨在通过开发预算影响模型 (BIM) 比较澳大利亚患者使用 Eluvia（一种新型紫杉醇洗脱支架）与使用药物涂层支架 Zilver PTX 治疗的 5 年财务影响。

方法

BIM 是从澳大利亚公立医院付款人的角度使用澳大利亚国家成本权重 (AUD)、已发表的文献和公立医院审计数据开发的。临床结果，包括临床驱动的 TLR (CD-TLR)、不良事件和住院时间，基于 IMPERIAL 试验的 2 年结果，该试验将 Eluvia DES 与 Zilver PTX 进行了比较。

结果

假设 EVP 合格率为 80%，DES 使用率为 10% 至 28%（仅限股浅动脉病变），5 年模型预测的治疗人群为 14,428 至 40,399 名患者。该模型估计，使用 Eluvia DES 后 CD-TLR 减少了 1499–4198 天，住院天数减少了 16,515–46,243 天。由于减少了 Eluvia DES 的 CD-TLR，这意味着澳大利亚公立医院付款人在 5 年内可能节省 4.3 至 1210 万美元，而澳大利亚公立医院则因不良事件和住院天数减少而节省了 33.1 至 9260 万美元。

结论

Eluvia DES 用作症状性下肢 PAD 的治疗可能会在改善患者预后的基础上为澳大利亚公共医疗保健系统带来潜在的节省。