Endovascular intervention for treatment of claudication: is it cost-effective?
BACKGROUND
Treatment of claudication with endovascular intervention (EVI), a procedure designed to enhance quality of life, is on the rise despite being expensive. We examined clinical outcomes and costs for treatment of claudication with EVI.


METHODS
Records of all EVI performed at a University Health Center during a single year were reviewed for functional capacity, Trans-Atlantic Inter-Society Council (TASC) classification, procedure, reintervention, and financial data. Sustained clinical success (SCS) (improvement without target extremity revascularization [TER]) and secondary sustained clinical success (SSCS) (improvement with TER) were tracked over 2 years follow-up.


RESULTS
There were 77 patients (90 limbs). Mean follow-up was 14.8 +/- 7.7 months (1-30). Procedural success was 94%. Two-year SCS and SSCS were found to be 28 +/- 9% and 49 +/- 11%, respectively. SCS differed significantly from TASC (p = 0.02), whereas SSCS did not (p = 0.33). Mean time to reintervention was 11.7 +/- 6.6 months. Two-year TER-free rate (65 +/- 7%) did not differ significantly by procedure (p = 0.26), the artery treated (p = 0.24), or TASC (p = 0.18). Two-year costs for EVI were $13,886, differing significantly by TASC (p = 0.017) and by the artery treated (p < 0.001). Estimated cost for a 3-month trial of supervised exercise and pharmacotherapy was $1,376, and the maintenance cost over a 2 year follow-up period was $6,602.


CONCLUSIONS
TER was necessary in more than one-third of limbs to maintain 2-year SSCS in 49% of patients. EVI was twice as expensive as estimated 2-year costs for supervised exercise and pharmacotherapy, and 10 times more costlier than a 3-month trial. Mandating a trial of conservative therapy before EVI merits consideration.
Sullivan
Timothy M
TM
Division of Vascular Surgery, Department of Surgery, University at Buffalo, Buffalo, NY 14209, USA.
O'Brien-Irr
Monica S
MS
Harris
Linda M
LM
Dosluoglu
Hasan H
HH
Dryjski
Maciej L
ML
D000046:Academic Medical Centers; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005081:Exercise Therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009518:New York; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000191:economics
D002317:Cardiovascular Agents