title: Significant savings with a stepped care model for treatment of patients with intermittent claudication.
abstract: OBJECTIVE
  International guidelines recommend supervised exercise therapy (SET) as primary treatment for intermittent claudication (IC). The aim of this study was to calculate treatment costs in patients with IC and to estimate nationwide annual savings if a stepped care model (SCM, primary SET treatment followed by revascularization in case of SET failure) was followed.
  
  
  METHODS
  Invoice data of all patients with IC in 2009 were obtained from a Dutch health insurance company (3.4 million members). Patients were divided into three groups based on initial treatment after diagnosis (t0). The SET group received SET initiated at any time between 12 months before and up to 3 months after t0. The intervention group (INT) underwent endovascular or open revascularization between t0 and t+3 months. The third group (REST) received neither SET nor any intervention. All peripheral arterial disease related invoices were recorded during 2 years and average costs per patient were calculated. Savings following use of a SCM were calculated for three scenarios.
  
  
  RESULTS
  Data on 4954 patients were analyzed. Initial treatment was SET (n = 701, 14.1%), INT (n = 1363, 27.5%), or REST (n = 2890, 58.3%). Within 2 years from t0, invasive revascularization in the SET group was performed in 45 patients (6.4%). Additional interventions (primary at other location and/or re-interventions) were performed in 480 INT patients (35.2%). Some 431 REST patients received additional SET (n = 299, 10.3%) or an intervention (n = 132, 4.5%). Mean total IC related costs per patient were €2,191, €9851 and €824 for SET, INT, and REST, respectively. Based on a hypothetical worst, moderate, and best case scenario, some 3.8, 20.6, or 33.0 million euros would have been saved per annum if SCM was implemented in the Dutch healthcare system.
  
  
  CONCLUSIONS
  Implementation of a SCM treatment for patients with IC may lead to significant savings of health care resources.
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
authors.forename: H J P
authors.initials: HJ
authors.lastname: Fokkenrood
authors.affiliation: Department of Vascular Surgery, Maxima Medical Center, Veldhoven, The Netherlands; CARIM Research School, Maastricht University, Maastricht, The Netherlands.
authors.forename: M R M
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M J W
authors.initials: MJ
authors.lastname: Koelemay
authors.affiliation: Department of Vascular Surgery, Martini Hospital, Groningen, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Breek
authors.affiliation: Department of Vascular Surgery, CZ, Tilburg, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Hasaart
authors.affiliation: Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI Research School, Maastricht University, Maastricht, The Netherlands. Electronic address: joep.teijink@cze.nl.
authors.forename: J A W
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D000368:Aged; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D017721:Hospital Costs; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics* / Q000628:therapy*; D008297:Male; D017146:Models, Organizational; D009426:Netherlands; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000191:economics*
keywords: Cost-analysis; Peripheral arterial disease; Treatment strategies