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

These are peer-reviewed supplementary materials for the article 'Supplementary materials: Digital variance angiography in patients undergoing lower limb arterial recanalization: cost–effectiveness analysis within the English healthcare setting' published in the Journal of Comparative Effectiveness Research.Supplementary equationAim: 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. Materials & methods: 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). Results: 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. Conclusion: 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.

本数据集为发表于《比较有效性研究杂志》的论文《补充材料：下肢动脉再通术患者数字方差血管造影：英格兰医疗保健环境中的成本-效益分析》的同行评审补充材料。补充方程目标：数字方差血管造影（DVA）是一种近期开发的图像处理方法，与传统的数字减影血管造影（DSA）相比，能够在进行下肢X光血管造影的患者中提升图像质量。本研究旨在从英格兰国家医疗服务体系的角度探讨DVA的潜在成本-效益。材料与方法：构建了一个包含决策树和马尔可夫模型的二部分经济模型，以考虑将DVA作为当前实践影像学的一部分使用时，与使用标准DSA的X光血管造影相关的成本和健康结果。该模型探讨了DVA对急性肾损伤（AKI）、慢性肾病和辐射诱导癌症在终身时间范围内的潜在影响。进行了确定性和概率性分析，以评估每质量调整生命年（QALY）的成本。结果：基准案例结果显示，DVA导致每位患者节省成本309英镑，QALYs也得到改善（+0.025）。敏感性分析显示，模型结果的关键驱动因素是DVA使用相关对比剂引起的急性肾损伤的相对风险（RR）降低。干预措施还降低了终身患癌的风险。情景分析表明，成本节省范围在310至553英镑之间，每位患者的QALY收益范围在0.048至0.109之间。结论：与现有成像实践相比，使用DVA可能在终身内降低成本并增加QALYs。该技术通过减少对比剂体积和辐射暴露，提供了一种经济上可行的现有图像处理方法替代方案的潜力已经得到证实。