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Inguinal Ligament
Right Common Femoral Artery
Right Profunda Femoral Artery
Right Superficial Femoral Artery
Right Popliteal Artery
Right Posterior Tibial Artery
Right Anterior Tibial Artery
Right Peroneal Artery
Improved Clinical Performance of a Lower Extremity Bypass GraftProvides Economic Value for Healthcare Providers
Darlene L. Krohn, PhD; Antoinette L. Sheen, MBA; Mike J. Martinell, MBA; Paul D. Goodman, PhD; Jennifer B. Recknor, PhD
W. L. Gore & Associates, Inc. • PO Box 2400 • Flagstaff, Arizona 86003–2400 • USA • [email protected]
IntroductionSynthetic lower extremity bypass grafts may require surgical reintervention to maintain blood flow as peripheral arterial disease (PAD) progresses.Multiple reinterventions are costly to health care systems and burdensome for patients. Further, failure to restore blood flow may result in amputation.The highest rate of reintervention occurs in bypasses to infrapopliteal arteries (Figure 1). The heparin-bonded GORE® PROPATEN® Vascular Graft (Figure 2) requires fewer reinterventions than standard ePTFE grafts, according to clinical literature.1–7
ObjectiveModel the cumulative average cost per patient of infrapopliteal bypass using the GORE® PROPATEN® Vascular Graft compared to standard ePTFE over a 3-year period.
MethodsCost of bypass procedures, follow-up visits and reinterventions (in USD) were obtained using Medicare national average cost methodology. Amputation and rehabilitation costs were determined from a clinical publication.8
Patency and limb salvage rates for GORE® PROPATEN® Vascular Graft and ePTFE grafts one to three years after infrapopliteal bypass were obtained from clinical literature. Cumulative average cost per patient was calculated by combining the cost of the bypass procedure and typical reinterventions.
Figure 1: Lower extremity arterial anatomy
Figure 2: GORE® PROPATEN® Vascular Graft
Results
Conclusion The clinical value of the GORE® PROPATEN® Vascular Graft—reduced amputation and reintervention rates—translates directly to the economic value of reduced cumulative cost over time.
Referencesa. Weighted average of data from references 1 –6.
b. Critical limb ischemia subset from reference 5.
1. Daenens K, et al. Journal of Vascular Surgery 2009;49(5):1210-1216.
2. Hugl B, et al. Journal of Cardiovascular Surgery 2009;50(2):195-203.
3. Kirkwood ML, et al. Vascular & Endovascular Surgery 45(4):329-334.
4. Lösel-Sadée H, Alefelder C. Journal of Cardiovascular Surgery 2009;50(3):339-343.
5. Peeters P, et al. Journal of Vascular & Endovascular Surgery 2008;15(3):143-148.
6. Pulli R, et al. Journal of Vascular Surgery 2010;51(5):1167-1177.
7. Albers M, et al. Journal of Vascular Surgery 2003;37(6):1263-1269.
8. MacKenzie EJ, et al. Journal of Bone and Joint Surgery 2007;89(8):1685-1692.
100
80
60
40
20
0
Primary Patency
71% 59% 62% 48% 53% 41%
1 Year 2 Years 3 Years
100
80
60
40
20
0
Secondary Patency
86% 66% 75% 57% 62% 51%
1 Year 2 Years 3 Years
100
80
60
40
20
0
Limb Salvage
90% 78% 90% 71% 86% 66%
1 Year 2 Years 3 Years
GORE® PROPATEN® Vascular Graft a Standard ePTFE 7
GORE® PROPATEN® Vascular Graft 5 Standard ePTFE 7
GORE® PROPATEN® Vascular Graft b Standard ePTFE 7
$45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
01 Year 2 Years 3 Years
Cumulative Average Cost Per Patient
$19,177 $23,476 $23,653 $33,830 $29,928 $44,835
GORE® PROPATEN® Vascular Graft Standard ePTFE
Products listed may not be available in all markets.GORE®, PERFORMANCE THROUGH DATA, PROPATEN®, and designs are trademarks of W. L. Gore & Associates. © 2012 W. L. Gore & Associates, Inc. AR0394-EN1 AUGUST 2012
®
