THE COST-EFFECTIVENESS OF TREATMENT OF SHORT OCCLUSIVE LESIONS IN THE FEMOROPOPLITEAL ARTERY - BALLOON ANGIOPLASTY VERSUS ENDARTERECTOMY

Objective: To compare the short- and long-term outcome and the costs involved in balloon angioplasty (BA) and thrombo-endarterectomy (EA) of shout femoropopliteal occlusions. Design: Retrospective study. Patients and methods: Forty-one lower limbs underwent EA from 1980 until 1988 and BA was performed in 62 limbs between 1988 and 1993. The two groups of patients were well matched for age, gender, cardiovascular risk-factors and the length of the femoropopliteal occlusions. In addition to clinical follow-up colour-Duplex scanning and intraarterial DSA were performed. Complete occlusions or significant restenoses were considered failure of the reconstruction. Actual costs were calculated by the hospital economic administration. Results: The 3-year primary patency in EA patients was 87% and in the BA group 44% (p = 0.0002). Redo procedures were required in seven (17%) patients with EA and in 24 (39%) with BA. Patency after redo procedures, i.e. tertiary patency, was 94% and 74% after 3 years in the EA and BA group respectively (p = 0.14). The mean cost of the primary treatment was higher in EA than in BA patients (p < 0.001). Mean total treatment costs including the expenses involved with redo procedures i were also higher in the group with EA than with BA (p < 0.001). However, the cost-effectiveness expressed as the total costs per month tertiary patency, was not significantly different for the two treatment groups; in patients with EA the ratio of total treatment costs and tertiary patency was NFl 309, and in patients with BA NFl 287. Conclusion: Contrary to the general view the expenses associated with surgical treatment are comparable with those of an endovascular procedure, if the costs are expressed as a cost-to-patency ratio.