Risk attitudes to treatment among patients with severe intermittent claudication.
OBJECTIVE
To determine claudication patients' risk attitude to invasive treatment and whether this treatment is cost effective.


METHODS
Quality of life and health state utility status of 50 consecutive patients with severe intermittent claudication was assessed and compared with ankle-brachial pressure index values (ABPI) and results from treadmill tests before and after endovascular or open revascularization. Health utility scores were then calculated and used in a cost-utility analysis.


RESULTS
Before surgery, patients were assigned a utility score of 0.51 (EQ-5D index) for their disease, and the standard gamble (SG) and time trade-off (TTO) median scores were 0.88 and 0.70, respectively. Before treatment, a weak correlation (r = 0.43, P < .001) between having a high risk perception of treatment and patients' walking distance were observed, where patients able to walk short distances accepted a higher risk. After treatment, ABI (P = .003) and walking distance (P = .002) improved significantly as well the physical components of the quality of life instruments (P < .001). The surgical treatment generated an improvement in quality of life expressed in QALYs equivalent to 0.17. With an estimated survival of 5 years, it adds up to a value of 0.85, corresponding to a sum of 51,000 US dollars gained.


CONCLUSIONS
Patients with severe intermittent claudication are risk-seeking when it comes to surgical treatment and their risk attitude is correlated to their walking ability and quality of life. The incremental QALYs gained by treatment are achieved at a reasonable cost and revascularization appears to be cost effective.
Letterstål
Anna
A
Section of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Forsberg
Christina
C
Olofsson
Pär
P
Wahlberg
Eric
E
D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020127:Recovery of Function; D018570:Risk Assessment; D012309:Risk-Taking; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000191:economics; D016138:Walking