Document Detail


A systematic review of lower extremity arterial revascularization economic analyses.
MedLine Citation:
PMID:  21971093     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Economic evaluation remains an understudied aspect of lower extremity vascular reconstructions. This study reviewed the economic-based literature with respect to open and endovascular treatment of peripheral arterial disease.
METHODS: This systematic review included economic analyses of open and endovascular treatment of lower extremity peripheral arterial disease, including claudication and critical limb ischemia. Studies were categorized as model-based, cost-consequences, or econometric cost-analyses. Clinical, financial, and time-based outcomes were examined.
RESULTS: From a candidate list of 1351 studies, 19 were appropriate for the review, comprising 3 model-based, 12 cost-consequence, and 4 cost-analyses. Because of the small numbers, claudication and critical limb ischemia studies were analyzed together. There was a trend favoring initial cost-savings with endovascular therapy. Whether this benefit is sustained over time is unknown. We were prevented from drawing cost-efficacy inferences because of a noted lack of standardized patient-centric outcomes, longitudinal data, and reintervention data.
CONCLUSIONS: The existing lower extremity arterial revascularization economic literature is inadequate for drawing cost-efficacy conclusions and cannot inform guidelines for open vs endovascular treatment. Overcoming this limitation will require the inclusion of cost (initial and reintervention) and patient-centric outcomes in future studies evaluating lower extremity revascularization technologies. All journals, particularly vascular journals, should enforce standard reporting guidelines of effectiveness and economic studies to enable appropriate comparative and cost-effectiveness analyses.
Authors:
James P Moriarty; Mohammad Hassan Murad; Nilay D Shah; Chaithra Prasad; Victor M Montori; Patricia J Erwin; Thomas L Forbes; Mark H Meissner; Michael C Stoner;
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-05     Completed Date:  2011-11-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1131-1144.e1     Citation Subset:  IM    
Copyright Information:
Copyright © 2011. Published by Mosby, Inc.
Affiliation:
Knowledge and Encounter Research Unit, Rochester, Minn., USA.
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MeSH Terms
Descriptor/Qualifier:
Cost Savings
Cost-Benefit Analysis
Endovascular Procedures / adverse effects,  economics*
Evidence-Based Medicine / standards
Health Care Costs*
Humans
Lower Extremity / blood supply*
Models, Econometric
Models, Economic
Peripheral Arterial Disease / economics*,  surgery,  therapy*
Research Design / standards
Treatment Outcome
Vascular Surgical Procedures / adverse effects,  economics*
Investigator
Investigator/Affiliation:
K Wayne Johnston / ; Enrico Ascher / ; Jack L Cronenwett / ; R Clement Darling / ; Lois A Killewich / ; Thomas F Lindsay / ; John J Ricotta /

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


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