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Tytuł:
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Editor's Choice - Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial.
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Autorzy:
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Djerf H; Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: .
Svensson M; School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Nordanstig J; Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department for Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Gottsäter A; Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Vascular Centre, Skåne University Hospital, Malmö, Sweden.
Falkenberg M; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Lindgren H; Vascular Centre, Skåne University Hospital, Malmö, Sweden; Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
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Źródło:
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European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2021 Oct; Vol. 62 (4), pp. 576-582. Date of Electronic Publication: 2021 Aug 25.
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Typ publikacji:
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Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2002-: London : Elsevier
Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995-
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MeSH Terms:
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Femoral Artery*
Health Care Costs*
Endovascular Procedures/*economics
Intermittent Claudication/*economics
Intermittent Claudication/*therapy
Peripheral Arterial Disease/*economics
Peripheral Arterial Disease/*therapy
Stents/*economics
Aged ; Cost-Benefit Analysis ; Endovascular Procedures/adverse effects ; Endovascular Procedures/instrumentation ; Female ; Humans ; Intermittent Claudication/diagnosis ; Male ; Peripheral Arterial Disease/diagnosis ; Quality-Adjusted Life Years ; Sweden ; Time Factors ; Treatment Outcome
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Contributed Indexing:
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Keywords: Cost effectiveness; Intermittent claudication; Stents
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Entry Date(s):
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Date Created: 20210829 Date Completed: 20211115 Latest Revision: 20211115
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Update Code:
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20240105
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DOI:
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10.1016/j.ejvs.2021.07.009
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PMID:
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34454817
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Objective: Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. non-invasive treatment.
Methods: One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3L™ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits.
Results: The mean cost per patient was €11 060 in the stent group and €4 787 in the control group, resulting in a difference of €6 273 per patient between the groups. The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of € 23 785 per QALY.
Conclusion: The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < €50 000 - €70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < £20 000 - £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.
(Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
