Ökonomische Analysen in der
Interventionellen Radiologie

Zusammenfassung

Abwägungen zwischen Kosten und medizinischer Wirkung gewinnen auch in der Interventionellen Radiologie zunehmend an Bedeutung. In dieser Übersichtsarbeit soll der Versuch unternommen werden, bisher publizierte Ergebnisse zu einigen häufiger angewendeten Interventionen zusammenfassend zu referieren. Ausgenommen sind neuroradiologische und koronarvaskuläre Interventionen. Wegen der insgesamt noch relativ geringen Datenmenge zu dem Thema wurden alle zum Thema relevanten Artikel referiert (n = 46) ohne Selektion nach methodischer Qualität. Für eine Reihe von radiologischen Interventionen konnte bereits Kosteneffektivität nachgewiesen werden, so z. B. für die Therapie femoropoplitealer und iliakaler Stenosen mit PTA, für Stenosen der Nierenarterien mit Stent, für den Cava-Filter und die Behandlung von malignen Ösophagus- und Gallenwegsstenosen mit Metallstents. Bei der Therapie des Bauchaortenaneurysmas liegen derzeit divergierende Teilergebnisse vor; hier müssen zukünftige Studien noch Klarheit schaffen. Bei den Iliakalgefäßen liegt bislang keine vergleichende Kosten-Effektivitäts-Analyse vor, die Bypass versus PTA + Stent untersucht, so dass auch hier noch abschließende Ergebnisse abgewartet werden müssen.

Abstract

Considerations about the relation between benefit and expenses are also gaining increasing importance in interventional radiology. This review aims at providing a survey about the published data concerning economical analyses of some of the more frequently employed interventions in radiology excluding neuroradiological and coronary interventions. Because of the relative scarcity of literature in this field, all identified articles (n = 46) were included without selection for methodological quality. For a number of radiological interventions the cost-effectiveness has already been demonstrated, e. g., PTA of femoropopliteal and iliac artery stenoses, stenting of renal artery stenoses, placement of vena-cava filters, as well as metal stents in malignant biliary and esophageal obstructions. Conflicting data exist for the treatment of abdominal aortic aneurysms. So far, no analysis could be found that directly compares bypass surgery versus PTA + stent in iliac arteries.

Schlüsselwörter

Kosten-Effektivitäts-Analysen - Kosten-Nutzen-Analysen - Interventionelle Radiologie - PTA - Stent

Key words

Cost-effectiveness analysis - Cost-benefit analysis - Interventional radiology - PTA - Stent

Literatur

• 1 Golder W. Decision analysis in radiology using Markov models.  Röfo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2000;  172 80-85
• 2 Fowkes F G. Cochrane Collaborative Review Group on peripheral vascular diseases: review abstract.  Eur J Vasc Endovasc Surg. 1999;  18 282-283
• 3 Hohn J, Arfvidsson B, Jivegard L, Lundgren F, Lundhohn K, Schersten T, Stenberg B, Tylen U, Zachrisson B F, Lindberg H. et al . Chronic lower limb ischaemia. A prospective randomised controlled study comparing the 1-year results of vascular surgery and percutaneous transluminal angioplasty (PTA).  Eur J Vasc Surg. 1991;  5 517-522
• 4 Tunis S R, Bass E B, Steinberg E P. The use of angioplasty, bypass surgery, and amputation in the management of peripheral vascular disease [see comments].  N EngI J Med. 1991;  325 556-562
• 5 Hunink M G, Meyerovitz M F. The use of angioplasty, bypass surgery, and amputation in the management of peripheral vascular disease [letter; comment].  N Engl J Med. 1992;  326 414
• 6 Wong J B, Sonnenberg F A, Salem D N, Pauker S G. Myocardial revascularization for chronic stable angina. Analysis of the role of percutaneous transluminal coronary angioplasty based on data available in 1989 [see comments].  Ann Intern Med. 1990;  113 852-871
• 7 Janosik J E, Bettmann M A, Kaul A F, Souney P F. Therapeutic alternatives for subacute peripheral arterial occlusion. Comparison by outcome, length of stay, and hospital charges.  Invest Radiol. 1991;  26 921-925
• 8 Hoch J R, Tullis M J, Acher C W, Heisey D M, Crummy A B, McDermott J C, Wojtowycz M, Sproat I A, Turnipseed W D. Thrombolysis versus surgery as the initial management for native artery occlusion: efficacy, safety, and cost.  Surgery. 1994;  116 649-656
• 9 Ouriel K, Kolassa M, DeWeese J A, Green R M. Economic implications of thrombolysis or operation as the initial treatment modality in acute peripheral arterial occlusion.  Surgery. 1995;  118 810-814
• 10 Duda S H, Banz K, Brehme U, Tepe G, Erley C M, Albes J, Wiskirchen J, Claussen C D. Kosten-Nutzen-Analyse renaler Revaskularisationen mittels operativer und nicht-operativer Verfahren (abstr.).  Röfo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1999;  170 101
• 11 Duda S H, Banz K, Brehme U, Erley C M, Albes J, Tepe G, Wiskirchen J, Claussen C D. Cost-effectiveness analysis of treatment of renal artery stenoses by medication, angioplasty, stenting, and surgery. Min Invas Ther, im Druck 2002
• 12 Plouin P -F, Chatellier G, Darné B, Raynaud A. Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group.  Hypertension. 1998;  31 823-829
• 13 Webster J, Marshall F, Abdalla M, Dominiczak A, Edwards R, Isles C G, Loose H, Main J, Padfield P, Russell I T. et al . Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group.  J Hum Hypertens. 1998;  12 329-335
• 14 van-Jaarsveld B, Krijnen P, Bartelink A, Dees A, Derkx F, Man I V, Schalekamp M. The Dutch Renal Artery Stenosis Intervention Cooperative (DRASTIC) Study: rationale, design and inclusion data.  J Hypertens Suppl. 1998;  16 S21-S27
• 15 Hunink M G, Cullen K A, Donaldson M C. Hospital costs of revascularization procedures for femoropopliteal arterial disease.  J Vasc Surg. 1994;  19 632-641
• 16 Hunink M G, Wong J B, Donaldson M C, Meyerovitz M F, de-Vries J, Harrington D P. Revascularization for femoropopliteal disease. A decision and cost-effectiveness analysis.  JAMA. 1995;  274 165-171
• 17 Muradin G SR, Hunink M G. Cost and Patency Rate Targets for the Development of Endovascular devices to treat femoropopliteal disease.  Radiology. 2001;  218 464-469
• 18 Vroegindeweij D, Idu M, Buth J, Nillesen C, Schol F P, Tielbeek A V. The cost-effectiveness of treatment of short occlusive lesions in the femoropopliteal artery: balloon angioplasty versus endarterectomy.  Eur J Vasc Endovasc Surg. 1995;  10 40-50
• 19 Ballard J L, Bergan J J, Singh P, Yonemoto H, Killeen J D. Aortoiliac stent deployment versus surgical reconstruction: analysis of outcome and cost [see comments].  J Vasc Surg. 1998;  28 94-101
• 20 Whatling P J, Gibson M, Torrie E P, Magee T R, Galland R B. Iliac occlusions: stenting or crossover grafting? An examination of patency and cost.  Eur J Vasc Endovasc Surg. 2000;  20 36-40
• 21 Williams J B, Watts P W, Nguyen V A, Peterson C L. Balloon angioplasty with intraluminal stenting as the initial treatment modality in aorto-iliac occlusive disease.  Am J Surg. 1994;  168 202-204
• 22 Bosch J L, Hunink M G. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease.  Radiology. 1997;  204 87-96
• 23 Tetteroo E, Haaring C, van-der-Graaf Y, van-Schaik J P, van-Engelen A D, Mali W P. Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions. Dutch Iliac Stent Trial Study Group.  Cardiovasc Intervent Radiol. 1996;  19 411-417
• 24 Bosch J L, Haaring C, Meyerovitz M F, Cullen K A, Hunink M G. Cost-effectiveness of percutaneous treatment of iliac artery occlusive disease in the United States.  AJR Am J Roentgenol. 2000;  175 517-521
• 25 Bosch J L, Tetteroo E, Mali W P, Hunink M G. Iliac arterial occlusive disease: cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty. Dutch Iliac Stent Trial Study Group.  Radiology. 1998;  208 641-648
• 26 Holzenbein J, Kretschmer G, Glanzl R, Schon A, Thurnher S, Winkelbauer F, Trubel W, Minar E, Ahmadi A, Huk I. et al . Endovascular AAA treatment: expensive prestige or economic alternative?.  Eur J Vasc Endovasc Surg. 1997;  14 265-272
• 27 Sternbergh W C, Money S R. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study.  J Vasc Surg. 2000;  31 237-244
• 28 Rosemurgy A S, Bloomston M, Zervos E E, Goode S E, Pencev D, Zweibel B, Black T J. Transjugular intrahepatic portosystemic shunt versus H-graft portocaval shunt in the management of bleeding varices: a cost-benefit analysis.  Surgery. 1997;  122 794-799
• 29 Russo M W, Zacks S L, Sandler R S, Brown R S. Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding.  Hepatology. 2000;  31 358-363
• 30 Nunn C R, Neuzil D, Naslund T, Bass J G, Jenkins J M, Pierce R, Morris J A J. Cost-effective method for bedside insertion of vena caval filters in trauma patients [see comments].  J Trauma. 1997;  43 752-758
• 31 Sing R F, Smith C H, Miles W S, Messick W J. Preliminary results of bedside inferior vena cava filter placement: safe and cost-effective [see comments].  Chest. 1998;  114 315-316
• 32 Greenfield L J. Cost vs value in vena caval filters [editorial; comment].  Chest. 1998;  114 9-10
• 33 Bhatia R S, Collingwood P, Bartlett P. Radiologic versus surgical placement of vena cava filters: a comparative study of cost, time and complications.  Can Assoc Radiol J. 1998;  49 79-83
• 34 Sarasin F P, Eckman M H. Management and prevention of thromboembolic events in patients with cancer-related hypercoagulable states: a risky business.  J Gen Intern Med. 1993;  8 476-486
• 35 Lammer J, Hausegger K A, Fluckiger F, Winkelbauer F W, Wildling R, Klein G E, Thurnher S A, Havelec L. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents.  Radiology. 1996;  201 167-172
• 36 Travis S, Nicholson T. Palliation of unresectable pancreatic malignant biliary obstruction: Results of a randomized trial comparing percutaneously placed metal and plastic endoprostheses.  J Intervent Radiol. 1997;  12 17-21
• 37 Wagner H J, Knyrim K, Vakil N, Klose K J. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial.  Endoscopy. 1993;  25 213-218
• 38 Tham T C, Carr L D, Vandervoort J, Wong R C, Lichtenstein D R, Van-Dam J, Ruymann F, Chow S, Bosco J J, Qaseem T. et al . Management of occluded biliary Wallstents.  Gut. 1998;  42 703-707
• 39 Knyrim K, Wagner H J, Bethge N, Keymling M, Vakil N. A controlled trial of an expansive metal stent for palliation of esophageal obstruction due to inoperable cancer [see comments].  N Engl J Med. 1993;  329 1302-1307
• 40 Birch J F, White S A, Berry D P, Veitch P S. A cost-benefit comparison of self-expanding metal stents and Atkinson tubes for the palliation of obstructing esophageal tumors.  Dis Esophagus. 1998;  11 172-176
• 41 Nicholson D A, Haycox A, Kay C L, Rate A, Attwood S, Bancewicz J. The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy.  Clin Radiol. 1999;  54 212-215
• 42 Vesely T M, Idso M C, Audrain J, Windus D W, Lowell J A. Thrombolysis versus surgical thrombectomy for the treatment of dialysis graft thrombosis: pilot study comparing costs.  J Vasc Interv Radiol. 1996;  7 507-512
• 43 Marston W A, Criado E, Jaques P F, Mauro M A, Burnham S J, Keagy B A. Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis access grafts [see comments].  J Vasc Surg. 1997;  26 373-380
• 44 Dougherty M J, Calligaro K D, Schindler N, Raviola C A, Ntoso A. Endovascular versus surgical treatment for thrombosed hemodialysis grafts: A prospective, randomized study.  J Vasc Surg. 1999;  30 1016-1023
• 45 Hoffer E K, Sultan S, Herskowitz M M, Daniels I D, Sclafani S JA. Prospective randomized trial of a metallic intravascular stent in hemodialysis graft maintenance.  J Vasc Intervent Radiol. 1997;  8 965-973
• 46 Duda S H, Banz K, Ouriel K, Tepe G, Pusich B, Bala M. Cost-effectiveness analysis of treatment of subacute peripheral artery occlusions with thrombolysis with and without adjunctive abciximab (abstr.).  J Vasc Intervent Radiol. 2001;  12 SS70