Cost-Effectiveness of Endovascular Intervention Versus Bypass Surgery in Patients With Chronic Limb-Threatening Ischemia and Principal Target Lesion in the Femoropopliteal Segment

• Background. Chronic limb-threatening ischemia (CLTI) commonly requires revascularization to alleviate symptoms and prevent amputation. This study investigates the cost-effectiveness of bypass surgery vs endovascular intervention in CLTI with femoropopliteal lesions. Methods. Between March 2011 and January 2015, a total of 160 CLTI patients, undergoing bypass surgery (n = 55) or endovascular intervention (n = 105), were included in a prospective cohort study. The main study endpoint was quality-adjusted life years (QALYs) based on self-registered EQ-5D-3L questionnaires. Costs were retrieved from the hospi-tal’s cost-per-patient system. The incremental cost-effectiveness ratio (ICER) was calculated as costs per gained QALY and per avoided amputation. Results. QALYs during 2 years of follow-up were 1.04 years (95% CI, 0.89-1.18) in the bypass group and 0.95 years (95% CI, 0.84-1.07) in the endovascular group, with no significant intergroup difference. Amputation-free survival was 78% in the bypass group and 59% in the endovascular group (P<.05). The mean total cost per patient was $42,900 (95% CI, 32,400-53,500) for bypass surgery and $22,200 (95% CI, 17,800-26,600) for endovascular treatment. The cost per gained QALY and per avoided amputation with bypass surgery vs endovascular intervention was $730,000 and $104,000, respec-tively. Conclusion. At 2 years, the mean total hospital cost post bypass surgery was almost twice the cost post endovascular intervention. Although amputation-free survival was higher after bypass surgery, there was no corresponding gain in generic health status. This led to a high additional cost per QALY gained and per amputation avoided with bypass surgery compared with endovascular intervention.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

bypass surgery

chronic limb-threatening ischemia

cost-effectiveness

endovascular intervention

quality-adjustelife years

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)