Supplementary materials: Digital variance angiography in patients undergoing lower limb arterial recanalization: cost–effectiveness analysis within the English healthcare setting

<b>These are peer-reviewed supplementary materials for the article '</b><b>Digital variance angiography in patients </b><b>undergoing lower limb arterial </b><b>recanalization: cost–effectiveness analysis </b><b>within the English healthcare setting</b><b>' published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplementary equation</b><b>Aim:</b> Digital variance angiography (DVA) is a recently developed image processing method capable of improving image quality compared with the traditionally used digital subtraction angiography (DSA),among patients undergoing lower limb x-ray angiography. This study aims to explore the potential cost–effectiveness of DVA from an English National Health Service perspective. <b>Materials &amp; methods:</b> A two-part economic model, consisting of a decision tree and a Markov model, was developed to consider the costs and health outcomes associated with the use of DVA as part of current practice imaging, compared with x-ray angiography using standard DSA. The model explored the impact of DVA on the development of acute kidney injury (AKI), chronic kidney disease and radiation-induced cancer over a lifetime horizon. Both deterministic and probabilistic analyses were performed to assess the cost per quality-adjusted life-year (QALY). <b>Results:</b> Base-case results indicate that DVA results in cost savings of £309 per patient, with QALYs also improving (+0.025) over a lifetime. As shown in sensitivity analysis, a key driver of model results is the relative risk (RR) reduction of contrast-associated acute kidney injury associated with use of DVA. The intervention also decreases the risk of carcinoma over a lifetime. Scenario analyses show that cost savings range from £310 to £553, with QALY gains ranging from 0.048 to 0.109 per patient. <b>Conclusion:</b> The use of DVA could result in a decrease in costs and an increase in QALYs over a lifetime, compared with existing imaging practice. The potential for this technology to offer an economically viable alternative to existing image processing methods, through a reduction in contrast media volume and radiation exposure, has been demonstrated.