Intermittent claudication: cost-effectiveness of revascularization versus exercise therapy

Area of Science:

• Vascular Surgery
• Health Economics
• Interventional Cardiology

Background:

• Intermittent claudication significantly impacts quality of life.
• Treatment options include exercise, angioplasty, and bypass surgery.
• Comparative cost-effectiveness data are crucial for clinical decision-making.

Purpose of the Study:

• To compare the costs, effectiveness, and cost-effectiveness of different treatment strategies for intermittent claudication.
• To evaluate societal cost-effectiveness using a Markov decision model.
• To analyze treatment strategies involving initial therapy and secondary options.

Main Methods:

• A Markov decision model was developed combining literature and patient data.
• Evaluated treatment options: exercise, percutaneous transluminal angioplasty (with stenting), and bypass surgery.
• Outcome measures included quality-adjusted life days, lifetime costs, and incremental cost-effectiveness ratios.

Main Results:

• Revascularization (angioplasty or bypass) improved effectiveness by 33-61 quality-adjusted life days versus exercise.
• Incremental cost-effectiveness ratio for angioplasty was $38,000/QALY gained; for bypass surgery, $311,000/QALY gained.
• Ratios were sensitive to patient age, coronary artery disease history, health values, and revascularization costs.

Conclusions:

• Bypass surgery for intermittent claudication offers a small effectiveness gain relative to its substantial costs.
• Angioplasty, when feasible, is more effective than exercise alone and cost-effective.
• Treatment decisions should consider individual patient factors and cost-effectiveness.