Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent...

Area of Science:

• Vascular Surgery
• Health Economics
• Clinical Practice Guidelines

Background:

• Supervised exercise therapy (SET) is recommended for intermittent claudication, but program availability and reimbursement are limited.
• Endovascular revascularization (ER) is an alternative primary treatment.
• Long-term cost-effectiveness data is needed to support SET adoption.

Purpose of the Study:

• To compare the cost-effectiveness of SET versus ER as a primary treatment for intermittent claudication.
• To inform clinical practice guidelines and healthcare policy regarding treatment options.

Main Methods:

• A Markov model was developed from a Dutch healthcare payer's perspective.
• Included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
• Utilized data from RCTs and medical literature, with sensitivity analyses.

Main Results:

• SET demonstrated cost savings over ER within a 5-year horizon (-€6412).
• ER was associated with higher costs per QALY gained compared to SET (€91,600).
• ER showed more favorable cost-effectiveness in patients with low baseline quality-of-life scores.

Conclusions:

• Supervised exercise therapy (SET) is a more cost-effective primary treatment for intermittent claudication than endovascular revascularization (ER).
• These findings support the implementation and reimbursement of SET programs in routine clinical practice.