title: [Cost and cost-effectiveness in the treatment of peripheral arterial occlusion disease - what is proven?].
abstract: BACKGROUND
  This overview comments on the health-care relevance of peripheral arterial occlusive disease (PAOD) in patients with intermittent claudication (IC) and critical limb ischaemia (CLI). We evaluated different treatment modalities in terms of cost-effectiveness.
  
  
  METHODS
  For the literature review, the Medline database (PubMed) was searched under the key words "critical limb ischemia AND cost", "critical limb ischemia AND economy", "peripheral arterial disease AND cost", "peripheral arterial disease AND economy".
  
  
  RESULTS
  In the years 2005 to 2009, the hospitalisations of patients with PAOD rose disproportionately in Germany by 20 %, to 483,961 hospital admissions. By comparison, hospital admissions altogether increased by only 8 %. The average in-patient costs were estimated to be approximately € 5000 per PAOD-patient - a rather conservative estimate. For the patient with IC the economic data position is clear, supervised exercise training is by far the most cost-effective treatment option, followed by percutaneous transluminal angioplasty (PTA) and finally the peripheral bypass. In accordance with the guidelines of the UK, the latter is therefore indicated only if PTA fails or is technically not possible. In patients with CLI, the situation is not obvious. Indeed, a short-term economic advantage can be calculated for the PTA, the long-term comparison of both methods, however, is impossible due to insufficient data. In addition, the risk factors for the patient have to be included in the calculation. This was indeed demonstrated in the short-term, but could not be analysed in the long-term follow-up.
  
  
  CONCLUSIONS
  The issue of greater cost-effectiveness of open or endovascular treatment in patients with CLI is uncertain, the studies and patient populations are too heterogeneous. Further studies are urgently needed to structure the sequence of the various treatment options in guidelines and clinical pathways.
authors.affiliation: Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum und St. Franziskus-Hospital Münster, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum und St. Franziskus-Hospital Münster, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Bisdas
authors.affiliation: Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum GmbH, Hamburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Debus
authors.affiliation: Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH (DIGG) der DGG, Wissenschaftlicher Berater, Burghausen, Deutschland.
authors.forename: R T
authors.initials: RT
authors.lastname: Grundmann
mesh_terms: D017130:Angioplasty / Q000191:economics; D001157:Arterial Occlusive Diseases / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D001158:Arteries / Q000601:surgery; D003362:Cost-Benefit Analysis / Q000191:economics*; D019091:Critical Pathways / Q000191:economics; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000191:economics; D005121:Extremities / Q000098:blood supply; D005858:Germany; D019983:Guideline Adherence / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D007511:Ischemia / Q000191:economics / Q000453:epidemiology / Q000628:therapy