Background and aims: Catheter-directed treatment has yielded promising results in acute pulmonary embolism (PE), but state-of-the-art health economic evaluation of interventional treatment options is needed for healthcare systems to endorse its integration into clinical practice. We sought to provide an evidence-based comprehensive evaluation of the cost-effectiveness of catheter-directed thrombolysis (CDT) in PE. Methods: A systematic review and meta-analysis were conducted to retrieve outcomes of patients with intermediate- or high-risk PE treated with CDT versus standard of care (SoC). A cost-effectiveness analysis (CEA) model was developed, comparing CDT with SoC from the healthcare provider's (payer's) and the societal perspective in Germany (population of 84 million). A dynamic budget impact analysis (BIA) model was applied, assuming gradually increasing adoption of CDT. Results: Over a 5-year time horizon, CDT resulted in 4.13 life-years (LY) and 3.58 quality-adjusted life years (QALY), compared to 3.90 LY and 3.38 QALY with SoC. From the payer's perspective, the incremental cost-utility ratio (ICUR) for CDT was Є27,349 per QALY. From the societal perspective, costs were lower for CDT than for SoC (Є33,313 versus Є37,501). Cost-effectiveness of CDT was confirmed when focusing on patients with intermediate-risk PE; it also persisted when only randomized controlled trials were considered. Probabilistic analysis confirmed the robustness of the model. BIA showed that, despite the higher upfront treatment costs of CDT in the acute phase, cost savings can be expected in the long term. Conclusions: In selected patients with acute PE, catheter-directed interventions may improve patient outcomes while remaining within the acceptable cost-effectiveness threshold.
Mohr et al. (Mon,) studied this question.