A Cost-Utility Analysis of Laser-Assisted Angioplasty for Peripheral Arterial Occlusions

Abstract

Despite the perception of many people that lasers represent the cutting edge of high-technology medicine, this form of medical technology has been subject to relatively little rigorous evaluation. This dearth of research relates particularly to economic evaluation, where there have been few attempts to justify the high cost of laser equipment. This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions. Using data from a range of sources, including a published randomized trial, a cost-utility model is developed to estimate the costs and benefits of the laser, relative to standard angioplasty. The best available data indicate a cost-effective role for the laser, but important areas of uncertainty exist, including the laser's secondary recanalization rate, which has been estimated on the basis of limited numbers of patients. This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context.

Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis

“…It is assumed that after a successful operation patients move into the asymptomatic health state, where they remain until they either die or suffer a loss of patency (failure). If a failure occurs, then, as with Sculpher et al 76 and Hunink et al, 77 it is assumed that the patient returns to their health status prior to the operation.…”

“…As with Sculpher et al 76 and Hunink et al 77 it is assumed that spontaneous improvement from CLI to IC (in the absence of an operation) does not occur. It should be noted that, if a patient's operation fails (at any time), then they return to their health state prior to the operation, not their health state when entering the model.…”

“…Health utility values for amputation and CLI are taken from Sculpher et al 76 Values for IC and asymptomatic disease are taken from two other studies. Utility values associated with systemic complications are based on reported values for myocardial infarction survivors.…”

“…Only reports of EQ-5D or SF-36 (when sufficient data were available for them to be mapped to EQ-5D) were included, the final values used being the average of the included values. Data for patients with CLI or an amputation were taken from Sculpher et al 76 It is assumed that PTA does not affect subsequent rates of mortality or morbidity and that repeat procedures have the same effectiveness as the initial procedure. Failure was taken to include both a loss of patency and symptom deterioration requiring reintervention.…”

Decision Analysis and the Implementation of Research Findings

“…For example, modelling was required to extrapolate the results of a trial evaluating the short term effects of different types of angioplasty from the information collected in the trial. 17 Decision analysis is also useful when a clinical problem requires input from more than one set of study results; the effects of 19 Decision analysis is used to determine how to maximise an individual's expected utilities. By obtaining the median values of utilities from a large number of people the methodology can also be used to derive expected utilities for the community.…”