A retrospective study using the Medical Data Vision (MDV) database in Japan has shown that the use of IVUS in EVT of the lower extremity is clinically effective and may reduce healthcare costs in the long term, presented by Dr. Yoshimitsu Soga of Kokura Memorial Hospital at the Speaker's Corner session at LINC 2022.
Impact of IVUS use on clinical outcomes and medical costs in real-life lower extremity EVT in Japan
Of 47,768 patients with a diagnosis of peripheral arterial disease registered in the Japanese MDV database who underwent EVT between April 2009 and July 2019, 9,845 who met the criteria were included in this study, and the patient background and clinical outcomes of 3,956 patients treated with IVUS guidance and 5,889 patients treated with angio-guided only (without IVUS or OCT) were examined.
Overall, in-hospital mortality was 9.61%, major amputation 2.66%, stent thrombosis 1.8%, and AMI 23% were reported, with no significant difference between the IVUS-guided and angio-guided groups after adjustment.
On the other hand, MALE (stent thrombosis, major amputation, and reintervention) was lower in the IVUS-guided group (13% vs. 31%: p<0.0001), but not significantly different after adjustment (p<0.1528). The risk of reintervention (11% vs. 30%: p<0.0001) and MACLE (55% vs. 65%: p<0.0001), a composite of MALE + AMI, stroke, and in-hospital death, was significantly lower in the IVUS-guided group after adjustment.
Total costs were higher in the IVUS-guided group in the first year, but declined during the 2-7 year follow-up period, and overall medical costs were significantly lower in the IVUS-guided group both before and after adjustment. The use of IVUS lowered the total cost per patient on average by USD 18,173 (95% CI USD 7,695-USD 28,595), and over the first 5 years, the IVUS-guided group had an average 9.1% lower total cost compared to the angio-guided group (p<0.0054).
“To the best of our knowledge, this is the first real-world evidence showing that IVUS-guided lower extremity EVT has favorable long-term clinical outcomes and healthcare costs in Asian patients with peripheral arterial disease," Dr. Soga concluded.
※コンテンツには、国内で未承認、適応外の医療機器、医薬品、または効能・効果/用法・用量の情報を含む場合がありますが、未承認、適応外の使用を推奨するものではありません。
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