Surgery or angioplasty for cost-effective renal revascularization?

The authors retrospectively compared the cost-effectiveness of percutaneous transluminal angioplasty with that of renal artery bypass surgery for treating renal artery stenosis, using the experiences of 52 patients treated for renovascular hypertension between 1977 and 1983. The expected results of treatment for angioplasty and surgery were taken from published literature and from experience. Based on the analysis, angioplasty is recommended for treating patients with fibromuscular disease, and patients less than 50 years old, while surgery is the preferred treatment for older patients and those with atherosclerotic disease. These strategies not only minimize the cost per life-year gained from treatment, but also maximize the life expectancy of treated patients. The results are quite robust for the discount rate used in the cost calculations, for variations in the expected rate of stenosis recurrence, and for variations in the treatment outcome probabilities.