Document Detail

Cost-effectiveness of exercise training to improve claudication symptoms in patients with peripheral arterial disease.
MedLine Citation:
PMID:  15678620     Owner:  NLM     Status:  MEDLINE    
Exercise rehabilitation is a proven, yet poorly available, treatment for intermittent claudication, the primary symptom of peripheral arterial disease (PAD). Exercise rehabilitation is effective, non-invasive, and associated with minimal cardiovascular risk in appropriate patients. Percutaneous transluminal angioplasty (PTA), especially of the iliac segment, is an alternative effective treatment for claudication. There are, however, minimal data currently available to compare the cost-effectiveness of these two interventions. We compared the cost-effectiveness of 3- and 6-month exercise programs with that of iliac PTA without stenting, using the incremental cost-effectiveness ratio [ICER = (Cost2 - Cost1)/(Effectiveness2 - Effectiveness1)]. The ICER represented the price of an additional meter walked derived from each treatment based on conservative models of success of each procedure and specific care assumptions. PTA and exercise efficacy data were derived from a literature review and exercise costs were modeled per the current CPT code 93668. Effectiveness was defined as absolute claudication distance (ACD) at 3 and 6 months. Three treatment alternatives were assessed: (1) no treatment, (2) PTA, and (3) exercise rehabilitation. At 3 months, PTA was more effective than exercise therapy and resulted in an additional 38 meters at an additional cost of $6719, for an ICER of $177/meter. At 6 months, however, exercise was more effective than PTA, resulting in an additional 137 meters walked, and costs less ($61 less per meter gained). In conclusion, exercise rehabilitation at 6 months is more effective and costs less than PTA, and is therefore cost-saving. The cost-effectiveness and availability of claudication treatments has national implications for future PAD care; however, data to inform these care choices can best be obtained in prospective clinical trials.
Charoen Treesak; Vijj Kasemsup; Diane Treat-Jacobson; John A Nyman; Alan T Hirsch
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Vascular medicine (London, England)     Volume:  9     ISSN:  1358-863X     ISO Abbreviation:  Vasc Med     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2005-01-31     Completed Date:  2006-08-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9610930     Medline TA:  Vasc Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  279-85     Citation Subset:  IM    
Faculty of Pharmacy, Srinakharinwirot University, Thailand.
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MeSH Terms
Angioplasty, Balloon / economics
Cost-Benefit Analysis
Exercise Therapy / economics*
Follow-Up Studies
Intermittent Claudication / economics*,  therapy*
Lower Extremity / blood supply*,  surgery
Patient Compliance
Peripheral Vascular Diseases / economics*,  therapy*
Program Evaluation / economics
Treatment Outcome
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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