Cost-utility analysis of early versus delayed endovascular intervention in critical limb-threatening ischemia patients with rest pain.
J Vasc Surg
; 77(1): 299-308.e2, 2023 01.
Article
em En
| MEDLINE
| ID: mdl-35843509
ABSTRACT
OBJECTIVE:
The prevalence of chronic limb-threatening ischemia (CLTI) and poor health outcomes are high in Germany. Serious consequences of CLTI such as amputation and mortality can be effectively prevented by the early use of evidence-based therapeutic measures such as endovascular intervention. We have developed a cost-utility analysis to compare endovascular intervention with bare metal stents (BMSs) and endovascular intervention after conservative treatment from the German payer perspective.METHODS:
A Markov model, with a 5-year time horizon and seven states, was developed (1) intervention, (2) stable 1, (3) major amputation, (4) reintervention, (5) stable 2, (6) care, and (7) all-cause death. Transition probabilities were obtained by pooling the outcomes from multiple clinical studies. The costs were estimated using data from the German diagnosis-related group system, the German rehabilitation fund, and related literature. Health-state utilities were obtained from the reported data. The primary outcomes were the quality-adjusted life-years (QALYs) and costs.RESULTS:
Early BMS intervention after 5 years resulted in a cost of 23,913 and an increase of 2.5 QALYs per patient, and endovascular intervention with BMS after conservative treatment after 5 years resulted in a cost of 18,323 and an increase of 2 QALYs per patient. The incremental cost-effectiveness ratio was 12,438. The number of major amputations was reduced by 6%. The results of the structural, deterministic, and probabilistic sensitivity analyses were robust.CONCLUSIONS:
Early endovascular intervention with BMS resulted in more QALYs and a reduced risk of major amputation for early-stage CLTI patients. Our results showed that early endovascular intervention is very cost-effective according to World Health Organization recommended cost-effectiveness thresholds. However, the clinical decision regarding the use of early endovascular intervention should be determined by individual patient-level eligibility and the physician's judgment.Palavras-chave
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Doença Arterial Periférica
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Procedimentos Endovasculares
Tipo de estudo:
Health_economic_evaluation
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Prognostic_studies
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Risk_factors_studies
Aspecto:
Patient_preference
Limite:
Humans
Idioma:
En
Revista:
J Vasc Surg
Assunto da revista:
ANGIOLOGIA
Ano de publicação:
2023
Tipo de documento:
Article