Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study

Objective: To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective. Methods: European multicentre study involving consecutive patients requiring femoropopliteal TLR (January 2017- December 2021). The primary outcome was overall cost (euros) associated with a TLR procedure from presentation to discharge. Exact costs per constituent, clinical characteristics, and early outcomes were reported. Results: This study included 482 TLR procedures (retrospectively, 13 hospitals, six countries): 56% were female, mean age was 75 +/- 2 years, 61% were Rutherford class 5 or 6, 67% had Tosaka class 3 disease, and 16% had common femoral or iliac involvement. A total of 52% were hybrid procedures and 6% involved open surgery only. Technical success was 70%, 30 day mortality rate was 1%, and the 30 day major amputation rate was 4%. Most costs were for operating time during the TLR (healthcare professionals ' salaries, indirect and estate costs), with a mean of: 21 917 +/- 2 110 for all procedures; 23 337 +/- 8 920 for open procedures; 12 903 +/- 3 108 for endovascular procedures; and 22 806 +/- 3 977 for hybrid procedures. In a regression analysis, procedure duration was the main parameter associated with higher overall TLR costs (coef fi cient, 2.77; standard error, 0.88; p < .001). The mean cost per operating minute of TLR (indirect, estate costs, all salaried staff present included) was 177 and the mean cost per night stay in hospital (outside intensive care unit) was 356. The mean cost per overnight intensive care unit stay (minimum of 8 hours per night) was 1 193. Conclusion: The main driver of the considerable peri-procedure costs associated with femoropopliteal TLR was procedure time.