A Projected Cost Analysis of Plain Balloon Versus Drug Coated Balloon Angioplasty for the Treatment of Femoropopliteal Segment Disease

INTRODUCTION: Peripheral arterial disease in the superficial femoral and popliteal arteries is common and increasingly treated with drug coated technologies. While drug coated balloons (DCB) are typically used following pre-dilatation with an uncoated balloon; the procedure and patient follow-up are otherwise essentially identical. Published literature demonstrates improved primary patency and reduced target lesion revascularisation with DCB use, however there is little published data on potential cost implications of using this additional device. We hypothesise there is cost equivalence with DCB use when adjusted for reduced re-intervention rate. METHODS: An updated systematic search was performed to identify reintervention rates, restricted to RCT level evidence. Weighted averages of reintervention rates at 1-5 year time points were applied to a local patient cohort, and cost projections calculated to 5 years based on assumed DCB device costs of $900 and $1500 (exaggerated). RESULTS AND CONCLUSION: In a claudicant biased population, cost projections favour DCB at 1, 2, 3, and 5 year time points. For the exaggerated cost group, DCB is also favourable at 1-3 years, with near equivalence at 5 years. Further benefits such as reduced hospital admissions, QALY and angiography suite opportunity costs are not assessed in our projections; but remain important considerations.