18891
document
In-hospital costs of self-expanding nitinol stent implantation versus balloon angioplasty in the femoropopliteal artery ( the VascuCoil Trial ) . PURPOSE Although several prospective studies have examined the safety and efficacy of stent placement for femoropopliteal arterial disease , the current cost of these procedures is unknown . To estimate and compare hospital costs associated with conventional balloon angioplasty ( percutaneous transluminal angioplasty [ PTA ] ) and stent placement for patients with symptomatic peripheral arterial disease , the authors performed a prospective economic evaluation in conjunction with the Intracoil Femoropopliteal Stent Trial ( VascuCoil ) . MATERIALS AND METHODS Between May 1997 and December 1999 , 266 patients with stenotic or occluded superficial femoral or popliteal arteries were prospectively randomized to treatment with the IntraCoil stent or PTA . Detailed resource use and cost data for each patient 's initial revascularization procedure and ensuing hospitalization were collected and analyzed on an intention-to-treat basis . RESULTS Compared with conventional balloon angioplasty , stent placement did not improve clinical outcomes but increased procedure duration , equipment costs , and physician services . As a result , initial hospital costs were approximately 3,500 dollars higher for patients randomized to the IntraCoil stent , compared with PTA ( 8,435 dollars vs 4,980 dollars ; P < .001 ) . CONCLUSIONS As performed in the VascuCoil trial , primary stent placement for femoropopliteal disease did not improve clinical outcomes but increased initial treatment costs by more than 3,000 dollars . Because there were no substantial differences in subsequent clinical outcomes between the two treatments , it is unlikely that these increased initial costs would be offset by savings in follow-up costs . These findings suggest that a strategy of routine stent implantation for patients undergoing femoropopliteal PTA is not optimal on economic grounds and that PTA with provisional stent implantation is preferred .
18892
Intervention_Physical
self-expanding nitinol stent implantation
18893
Intervention_Physical
balloon angioplasty
18894
Intervention_Physical
stent placement
18895
Intervention_Physical
conventional balloon angioplasty ( percutaneous transluminal angioplasty [ PTA ] )
18896
Intervention_Physical
stent placement
18897
Intervention_Physical
IntraCoil stent
18898
Intervention_Physical
PTA
18899
Intervention_Physical
conventional balloon angioplasty
18900
Intervention_Physical
stent placement
18901
Intervention_Physical
IntraCoil stent
18902
Intervention_Physical
PTA
18903
Intervention_Physical
stent
18904
Intervention_Physical
PTA
18905
Intervention_Physical
PTA
18906
Intervention_Physical
provisional stent implantation
18907
Outcome_Other
In-hospital costs
18908
Outcome_Other
safety
18909
Outcome_Other
efficacy
18910
Outcome_Other
hospital costs
18911
Outcome_Other
resource use
18912
Outcome_Other
cost data
18913
Outcome_Physical
clinical outcomes
18914
Outcome_Other
procedure duration , equipment costs , and physician services .
18915
Outcome_Other
initial hospital costs
18916
Outcome_Physical
clinical outcomes
18917
Outcome_Other
initial treatment costs
18918
Outcome_Physical
clinical outcomes
18919
Outcome_Other
initial costs
18920
Outcome_Other
follow-up costs .
18921
Participant_Condition
femoropopliteal arterial disease
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Participant_Sample-size
266
18923
Participant_Condition
stenotic or occluded superficial femoral or popliteal arteries
18924
Participant_Condition
patients undergoing femoropopliteal PTA