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Cost-effectiveness of supervised exercise, stenting, and optimal medical care for claudication: results from the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) trial.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2014 Nov 11; Vol. 3 (6), pp. e001233. Date of Electronic Publication: 2014 Nov 11. - Publication Year :
- 2014
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Abstract
- Background: Both supervised exercise (SE) and stenting (ST) improve functional status, symptoms, and quality of life compared with optimal medical care (OMC) in patients with claudication. The relative cost-effectiveness of these strategies is not well defined.<br />Methods and Results: The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study randomized patients with claudication due to aortoiliac stenosis to a 6-month SE program, to ST, or to OMC. Participants who completed 6-month follow-up (n=98) were included in a health economic analysis through 18 months. Costs were assessed using resource-based methods and hospital billing data. Quality-adjusted life-years were estimated using the EQ-5D. Markov modeling based on the in-trial results was used to explore the impact of assumptions about the longer term durability of observed differences in quality of life. Through 18 months, mean healthcare costs were $5178, $9804, and $14 590 per patient for OMC, SE, and ST, respectively. Measured quality-adjusted life-years through 18 months were 1.04, 1.16, and 1.20. In our base case analysis, which assumed that observed differences in quality of life would dissipate after 5 years, the incremental cost-effectiveness ratios were $24 070 per quality-adjusted life-year gained for SE versus OMC, $41 376 for ST versus OMC, and $122 600 for ST versus SE. If the treatment effect of ST was assumed to be more durable than that of SE, the incremental cost-effectiveness ratio for ST versus SE became more favorable.<br />Conclusions: Both SE and ST are economically attractive by US standards relative to OMC for the treatment of claudication in patients with aortoiliac disease. ST is more expensive than SE, with uncertain incremental benefit.<br />Clinical Trial Registration Url: www.clinicaltrials.gov, Unique identifier: NCT00132743.<br /> (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Subjects :
- Ambulatory Care economics
Aortic Diseases diagnosis
Aortic Diseases physiopathology
Constriction, Pathologic
Cost-Benefit Analysis
Drug Costs
Endovascular Procedures adverse effects
Exercise Therapy adverse effects
Hospital Costs
Humans
Intermittent Claudication diagnosis
Intermittent Claudication physiopathology
Life Expectancy
Models, Economic
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease physiopathology
Quality of Life
Quality-Adjusted Life Years
Time Factors
Treatment Outcome
United States
Vascular Patency
Aortic Diseases economics
Aortic Diseases therapy
Cardiovascular Agents economics
Cardiovascular Agents therapeutic use
Endovascular Procedures economics
Endovascular Procedures instrumentation
Exercise Therapy economics
Health Care Costs
Iliac Artery physiopathology
Intermittent Claudication economics
Intermittent Claudication therapy
Peripheral Arterial Disease economics
Peripheral Arterial Disease therapy
Stents economics
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 3
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 25389284
- Full Text :
- https://doi.org/10.1161/JAHA.114.001233