Using the Evaluating Devices Using Claims And RegisTry Data (EDUCATe) Plan within the Vascular Implant Surveillance and Interventional Outcomes Network (VISION) to analyze the long-term outcomes following endovascular aortic aneurysm repair.
Academic Article
Overview
abstract
OBJECTIVES: Implanted devices undergo clinical trials to assess their safety and effectiveness. However, pivotal device trials are limited in their follow-up while post-market surveillance may incompletely capture late failure. Linking clinical trials to Medicare claims can address these limitations. This study matched patients from investigational device exemption (IDE) clinical trials for endovascular aortic aneurysm repair (EVAR) to Medicare claims-based registry data to compare long-term device outcomes between the two sources. METHODS: Patient-level data from two industry-sponsored IDE trials of EVAR devices was provided by a single industry partner. Trial data was matched at the patient-level to data from the Vascular Implant Surveillance and Interventional Outcomes Network (VISION), a registry that is part of the Society for Vascular Surgery Patient Safety Organization. The primary outcomes analyzed were survival and freedom from aneurysm-related reintervention. RESULTS: Of 159 clinical trial patients, 134 were eligible for claims-based matching and 115 (85.5%) were successfully matched to VISION registry data. For the matched cohort, the Kaplan-Meier estimated survival was 94.8% at one year, 82.6% at three years, and 68.1% at five years. Estimates for freedom from reintervention were 90% at one year, 82.4% at three years, and 78.1% at five years. The estimates for survival were nearly identical between the clinical trial data and that found in the VISION data (log-rank p=0.89). Freedom from reintervention was similar between the groups, with IDE trial reported freedom from reintervention of 87.3% and 73.3%, compared to VISION of 92.6% and 83% at one and five years, respectively (log-rank p=0.13). CONCLUSIONS: Clinical trial patients who undergo EVAR can be successfully matched to claims-based registry data to improve long-term device surveillance and outcomes reporting. Claims-based results agreed well with IDE trial results for patients through 5 years, supporting the accuracy of claims-based data for longer-term surveillance. Linking clinical trial and claims-based registry data can lead to robust device monitoring.
