The cost-effectiveness of exclusion arteriography in extremity trauma

The purpose of this study was to apply decision analysis to an established practice in vascular trauma diagnosis. While exclusion arteriography has resulted in an increase in positive surgical explorations, no formal analysis that determined either the cost-effectiveness of exclusion arteriography or the cost-effectiveness ratio has been reported in the literature. We created a decision model that compared exclusion arteriography and surgical exploration, the standard used prior to the development of extremity arteriography. The decision model used predominantly literature derived estimates for the prevalence of arterial injuries and the accuracy, complications, outcomes and costs of both arteriography and exploration. Exclusion arteriography is cost-effective. This finding is robust to changes in the major model variables. Compared to surgical exploration, exclusion arteriography is a superior strategy by dominance (more effective and costs less). Therefore, a cost-effectiveness ratio cannot be calculated. Under the base case assumption of 28% prevalence of arterial injury requiring operation, exclusion arteriography saves about $2000 and adds 0.3 quality adjusted life years (QALY) for each patient. Decision analysis can be successfully applied to problems in vascular trauma diagnosis.