Percutaneous stenting of incidental unilateral renal artery stenosis: Decision analysis of costs and benefits

David A. Axelrod, A. Mark Fendrick, Ruth C. Carlos, Robert J. Lederman, James B. Froehlich, Alan B. Weder, Paul H. Abrahamse, James C. Stanley

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S). Methods: The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death. Results: Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year. Conclusions: PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.

Original languageEnglish (US)
Pages (from-to)546-556
Number of pages11
JournalJournal of Endovascular Therapy
Issue number3
StatePublished - Jun 2003


  • Balloon angioplasty
  • Cost comparison
  • Decision analysis
  • Markov modeling
  • Renal artery stenosis
  • Stent

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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