Intermittent claudication: cost-effectiveness of revascularization versus exercise therapy.
OBJECTIVE
To compare the costs, effectiveness, and cost-effectiveness of alternative treatment strategies for intermittent claudication.


METHODS
By combining data from the literature and original patient data, a Markov decision model was developed to evaluate the societal cost-effectiveness. Patients presented with previously untreated intermittent claudication, and treatment options were exercise, percutaneous transluminal angioplasty (with stent placement, if necessary), and/or bypass surgery. Treatment strategies were defined as the initial therapy in combination with secondary treatment options should the initial therapy fail. The main outcome measures were quality-adjusted life days, expected lifetime costs (in 1995 U.S. dollars), and incremental cost-effectiveness ratios.


RESULTS
Compared with an exercise program, revascularization (either angioplasty or bypass surgery) improved effectiveness by 33-61 quality-adjusted life days among patients with no history of coronary artery disease. The incremental cost-effectiveness ratio was $38,000 per quality-adjusted life year gained when angioplasty was performed whenever feasible, as compared with exercise alone, and $311,000 with additional bypass surgery. The incremental cost-effectiveness ratios were sensitive to age, history of coronary artery disease, estimated health values for no or mild claudication versus severe claudication, and revascularization costs.


CONCLUSIONS
The results suggest that, on average, the expected gain in effectiveness achieved with bypass surgery for intermittent claudication is small compared with the costs. Angioplasty performed whenever feasible was more effective than was exercise alone, and the cost-effectiveness ratio was within the generally accepted range.
de Vries
Sybolt O
SO
Department of Health Sciences, University of Groningen, the Netherlands.
Visser
Karen
K
de Vries
Jelle A
JA
Wong
John B
JB
Donaldson
Magruder C
MC
Hunink
M G Myriam
MG
D017130:Angioplasty / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005081:Exercise Therapy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D008390:Markov Chains; D016491:Peripheral Vascular Diseases / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D015607:Stents / Q000191:economics; D016896:Treatment Outcome