title: Clinical outcomes and cost-effectiveness of initial treatment strategies for nonembolic acute limb ischemia in real-life clinical settings.
abstract: OBJECTIVE
  The optimal initial treatment for patients with acute limb ischemia (ALI) remains undefined. Although clinical outcome data are inconsistent, catheter-directed thrombolysis (CDT) with tissue plasminogen activator is increasingly used. Patient-level analysis combining clinical and economic data in a real-life setting is lacking. This study compared clinical outcomes and cost-effectiveness of initial treatment strategies for nonembolic ALI using real-life patient-level data.
  
  
  METHODS
  Medical records and data for hospital costs were analyzed for nonembolic ALI patients treated in four hospitals over 3 years. A cost-effectiveness analysis was performed using a decision tree analytic model. All costs were valued based on cost-to-charge ratios.
  
  
  RESULTS
  In 205 patients, initial treatments were CDT alone in 68 or with angioplasty in 16, open surgery in 60, endovascular in 33, and hybrid in 28. Although clinical outcomes did not differ significantly among the groups, reintervention rates during hospital stay, readmission rates, and costs were highest in the CDT group. Reintervention was required in 62% of patients after CDT compared with 7% after open surgery, and 16% of the CDT patients needed more than one reintervention. The mean total hospital cost was $34,800 per patient in CDT group compared with $10,677 in open surgery group.
  
  
  CONCLUSIONS
  In this real-life study, initial treatment of nonembolic ALI with currently available CDT options was associated with greater health care resource consumption and cost compared with other initial treatment options.
authors.affiliation: Jobst Vascular Institute, Toledo, Ohio. Electronic address: fedor.lurie@promedica.org.
authors.forename: Fedor
authors.initials: F
authors.lastname: Lurie
authors.affiliation: College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio.
authors.forename: Varun
authors.initials: V
authors.lastname: Vaidya
authors.affiliation: Jobst Vascular Institute, Toledo, Ohio.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Comerota
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D007902:Length of Stay / Q000191:economics; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D019233:Retreatment / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics*