Document Detail

Intermittent claudication: cost-effectiveness of revascularization versus exercise therapy.
MedLine Citation:
PMID:  11756701     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To compare the costs, effectiveness, and cost-effectiveness of alternative treatment strategies for intermittent claudication. MATERIALS AND METHODS: By combining data from the literature and original patient data, a Markov decision model was developed to evaluate the societal cost-effectiveness. Patients presented with previously untreated intermittent claudication, and treatment options were exercise, percutaneous transluminal angioplasty (with stent placement, if necessary), and/or bypass surgery. Treatment strategies were defined as the initial therapy in combination with secondary treatment options should the initial therapy fail. The main outcome measures were quality-adjusted life days, expected lifetime costs (in 1995 U.S. dollars), and incremental cost-effectiveness ratios. RESULTS: Compared with an exercise program, revascularization (either angioplasty or bypass surgery) improved effectiveness by 33-61 quality-adjusted life days among patients with no history of coronary artery disease. The incremental cost-effectiveness ratio was $38,000 per quality-adjusted life year gained when angioplasty was performed whenever feasible, as compared with exercise alone, and $311,000 with additional bypass surgery. The incremental cost-effectiveness ratios were sensitive to age, history of coronary artery disease, estimated health values for no or mild claudication versus severe claudication, and revascularization costs. CONCLUSION: The results suggest that, on average, the expected gain in effectiveness achieved with bypass surgery for intermittent claudication is small compared with the costs. Angioplasty performed whenever feasible was more effective than was exercise alone, and the cost-effectiveness ratio was within the generally accepted range.
Sybolt O de Vries; Karen Visser; Jelle A de Vries; John B Wong; Magruder C Donaldson; M G Myriam Hunink
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Radiology     Volume:  222     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2001-12-28     Completed Date:  2002-02-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  25-36     Citation Subset:  AIM; IM    
Department of Health Sciences, University of Groningen, the Netherlands.
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MeSH Terms
Angioplasty / economics*,  methods
Cost-Benefit Analysis
Decision Trees
Exercise Therapy / economics*
Health Care Costs
Intermittent Claudication / economics*,  surgery,  therapy*
Markov Chains
Peripheral Vascular Diseases / economics*,  surgery,  therapy*
Quality-Adjusted Life Years
Stents / economics
Treatment Outcome

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