Iliac arterial occlusive disease: cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty. Dutch Iliac Stent Trial Study Group.

PURPOSE To evaluate the relative benefits and cost-effectiveness of treating iliac arterial occlusive disease with various interventions. MATERIALS AND METHODS Cost-effectiveness was analyzed in a hypothetical cohort of patients with intermittent claudication caused by an iliac arterial stenosis. Primary stent placement, percutaneous transluminal angioplasty (PTA), and PTA with selective stent placement were analyzed. Reduction in the risk of failure after primary stent placement versus that after PTA with selective stent placement, quality of life, and cost data were derived from results of a randomized, controlled trail. Complication rates, patency results, and the reduction in risk of failure were derived from a published meta-analysis. RESULTS PTA with selective stent placement yielded equivalent complication rates, patency results, and quality-of-life outcomes compared with those of primary stent placement, and the latter cost +957 less (95% confidence interval = +726, +1,188). PTA with selective stent placement was more expensive than PTA alone but yielded higher patency results (relative risk of long-term failure, 0.61; 95% confidence interval = 0.49, 0.75) and quality-adjusted life expectancy (0.2 quality-adjusted life year [QALY] gained) and had an incremental cost-effectiveness ratio of less than +20,000 per QALY gained. CONCLUSION PTA with selective stent placement is a cost-effective treatment strategy compared with primary stent placement or PTA alone in the treatment of intermittent claudication caused by an iliac arterial stenosis.