Journal article
Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits
Journal of endovascular therapy, Vol.10(3), pp.546-556
06/2003
DOI: 10.1583/1545-1550(2003)010<0546:PSOIUR>2.0.CO;2
PMID: 12932167
Abstract
Purpose: To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S). Methods: The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death. Results: Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year. Conclusions: PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.
Details
- Title: Subtitle
- Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits
- Creators
- David A. Axelrod - University of Michigan–Ann ArborA. Mark Fendrick - University of Michigan–Ann ArborRuth C. Carlos - University of Michigan–Ann ArborRobert J. Lederman - National Institutes of HealthJames B. Froehlich - #N# 6 Section of Vascular Medicine, University of Massachusetts, Worchester, Massachusetts, USAAlan B. Weder - University of Michigan–Ann ArborPaul H. Abrahamse - #N# 4 Department of Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies (CHOICES), University of Michigan Medical Center, Ann Arbor, MichiganJames C. Stanley - University of Michigan–Ann Arbor
- Resource Type
- Journal article
- Publication Details
- Journal of endovascular therapy, Vol.10(3), pp.546-556
- DOI
- 10.1583/1545-1550(2003)010<0546:PSOIUR>2.0.CO;2
- PMID
- 12932167
- ISSN
- 1526-6028
- eISSN
- 1545-1550
- Language
- English
- Date published
- 06/2003
- Academic Unit
- Surgery
- Record Identifier
- 9984322932102771
Metrics
15 Record Views