Back to Search
Start Over
Endovascular intervention for treatment of claudication: is it cost-effective?
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2010 Aug; Vol. 24 (6), pp. 833-40. - Publication Year :
- 2010
-
Abstract
- Background: Treatment of claudication with endovascular intervention (EVI), a procedure designed to enhance quality of life, is on the rise despite being expensive. We examined clinical outcomes and costs for treatment of claudication with EVI.<br />Methods: Records of all EVI performed at a University Health Center during a single year were reviewed for functional capacity, Trans-Atlantic Inter-Society Council (TASC) classification, procedure, reintervention, and financial data. Sustained clinical success (SCS) (improvement without target extremity revascularization [TER]) and secondary sustained clinical success (SSCS) (improvement with TER) were tracked over 2 years follow-up.<br />Results: There were 77 patients (90 limbs). Mean follow-up was 14.8 +/- 7.7 months (1-30). Procedural success was 94%. Two-year SCS and SSCS were found to be 28 +/- 9% and 49 +/- 11%, respectively. SCS differed significantly from TASC (p = 0.02), whereas SSCS did not (p = 0.33). Mean time to reintervention was 11.7 +/- 6.6 months. Two-year TER-free rate (65 +/- 7%) did not differ significantly by procedure (p = 0.26), the artery treated (p = 0.24), or TASC (p = 0.18). Two-year costs for EVI were $13,886, differing significantly by TASC (p = 0.017) and by the artery treated (p < 0.001). Estimated cost for a 3-month trial of supervised exercise and pharmacotherapy was $1,376, and the maintenance cost over a 2 year follow-up period was $6,602.<br />Conclusions: TER was necessary in more than one-third of limbs to maintain 2-year SSCS in 49% of patients. EVI was twice as expensive as estimated 2-year costs for supervised exercise and pharmacotherapy, and 10 times more costlier than a 3-month trial. Mandating a trial of conservative therapy before EVI merits consideration.<br /> (Copyright 2010. Published by Elsevier Inc.)
- Subjects :
- Academic Medical Centers
Aged
Angioplasty adverse effects
Angioplasty instrumentation
Cardiovascular Agents economics
Cardiovascular Agents therapeutic use
Chi-Square Distribution
Cost-Benefit Analysis
Drug Costs
Exercise Therapy economics
Female
Humans
Intermittent Claudication physiopathology
Kaplan-Meier Estimate
Male
Middle Aged
New York
Retrospective Studies
Stents economics
Time Factors
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures economics
Angioplasty economics
Health Care Costs
Intermittent Claudication economics
Intermittent Claudication therapy
Outcome and Process Assessment, Health Care economics
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 24
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 20638623
- Full Text :
- https://doi.org/10.1016/j.avsg.2010.03.025