title: Cost-effectiveness of exercise therapy in patients with intermittent claudication: supervised exercise therapy versus a 'go home and walk' advice.
abstract: OBJECTIVE
  The Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study has shown supervised exercise therapy (SET) to be more effective regarding walking distance and quality of life than a 'go home and walk' advice (WA) for patients with intermittent claudication. The present study aims to assess the cost-effectiveness of SET versus WA.
  
  
  METHODS
  Data from the EXITPAD study, a 12-month randomised controlled trial in 304 patients with claudication, was used to study the proportion of costs to walking distance and quality of life. Two different incremental cost-effectiveness ratios (ICERs) were calculated for SET versus WA: costs per extra metre on the treadmill test, and costs per quality-adjusted life year (QALY). QALYs were based on utilities derived from the EuroQoL-5 dimensions (EQ-5D).
  
  
  RESULTS
  Mean total costs were higher for SET than for WA (3407 versus 2304 Euros), mainly caused by the costs of exercise therapy. The median walking distance was 620 m for SET and 400 m for WA. QALYs were 0.71 for SET and 0.67 for WA. All differences were statistically significant. The ICER for cost per extra metre on the 12-month treadmill test was € 4.08. For cost per QALY, the ICER was € 28,693.
  
  
  CONCLUSIONS
  At a willingness-to-pay threshold of € 40,000 per QALY, SET likely is a cost-effective therapeutic option for patients with claudication.
authors.affiliation: Maastricht University Medical Center, Department of Clinical Epidemiology and Medical Technology Assessment, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: A D I
authors.initials: AD
authors.lastname: van Asselt
authors.forename: S P A
authors.initials: SP
authors.lastname: Nicolaï
authors.forename: M A
authors.initials: MA
authors.lastname: Joore
authors.forename: M H
authors.initials: MH
authors.lastname: Prins
authors.forename: J A W
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics* / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016138:Walking / Q000191:economics*