Cost determinants of percutaneous and surgical interventions for treatment of intermittent claudication from the perspective of the hospital.
OBJECTIVE
To identify pretreatment predictors of procedural costs in percutaneous and surgical interventions for intermittent claudication due to aortoiliac and/or femoropopliteal disease.


METHODS
A retrospective study was conducted in 97 consecutive patients who underwent percutaneous or surgical interventions over 15 months at a tertiary care center. Nineteen clinical predictive variables were collected at baseline. Procedural costs (outcome) were assessed from the perspective of the hospital by direct calculation, not based on ratios of costs-to-charges. A multivariable regression model was built to identify significant cost predictors. Follow-up information was obtained to provide multidimensional assessment of clinical outcome, including technical success (arteriographic score) and clinical result (changes in ankle-brachial pressure index; cumulative patency, mortality, and complication rates).


RESULTS
The linear regression model shows that procedural costs per patient are 25% lower in percutaneous patients (versus surgical), 42% lower for patients without rest pain than for those with, 28% lower if treated lesions are unilateral (versus bilateral), 12% lower if the treated lesion is stenotic rather than occlusive, 34% higher in sedentary patients, and 11% higher in patients with a history of cardiac disease. After a mean clinical follow-up >2 years, between-group differences between percutaneous and surgical patients were small and of limited significance in all dimensions of clinical outcome.


CONCLUSIONS
Predictors of clinical outcome are different from predictors of costs, and one should include both types of variables in the decision-making process. The choice of percutaneous versus surgical strategy, the presence of rest pain, and the bilaterality of the culprit lesions were the main pretreatment determinants of procedural costs. When possible choices of treatment strategy overlap, percutaneous treatment should provide an acceptable result that is less expensive (although not equal to surgery).
Janne d'Othée
Bertrand
B
Department of Radiology, Cardiovascular Imaging & Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street - GRB-290, Boston 02114-2696, USA. bjannedothee@partners.org
Morris
Michael F
MF
Powell
Richard J
RJ
Bettmann
Michael A
MA
D000800:Angioplasty, Balloon / Q000191:economics* / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D011237:Predictive Value of Tests; D015642:Radiology, Interventional / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D014654:Vascular Patency