title: Cost-Effectiveness Analysis of Initial Treatment Strategies for Nonembolic Acute Limb Ischemia Using Real-Word Data.
abstract: BACKGROUND
  Nonembolic acute limb ischemia (ALI) is a condition characterized by a sudden decrease in limb perfusion and requires immediate interventions. There are multiple treatment options available including surgery, catheter-directed thrombolysis (CDT), endovascular procedures, and hybrid treatment (a combination of open and endovascular techniques). Randomized trials provide information only on clinical efficacy, but not on economic outcomes. The objective of the study was to perform the cost-effective analysis comparing different treatment alternatives of ALI.
  
  
  METHODS
  The data were collected from 4r ProMedica community hospitals in the Northwest Ohio from January 2009 to December 2012. Patients were included if they were treated within 14 days of onset of symptoms for nonembolic ALI and were divided into groups of receiving CDT, surgery, endovascular, or hybrid treatments. Demographics, comorbidities, medications taken before admission, and smoking status were collected at baseline for all patients and were compared among the treatment groups. A cost-effectiveness decision tree was developed to calculate expected costs and life years gained associated with available treatment options. A probabilistic sensitivity analysis was also performed to check the robustness of the model.
  
  
  RESULTS
  A population of 205 patients with the diagnosis of ALI was included and divided into different treatment groups. There was no major significant difference in baseline characteristics among the studied groups (P > 0.05). The total costs were $17,163.47 for surgery, $20,620.39 for endovascular, $21,277.61 for hybrid, and $30,675.42 for CDT. The life years gained were 17.25 for surgery, 18 for endovascular, 18 for hybrid, and 17 for CDT. CDT was dominated because of the high cost and the low effectiveness, while hybrid treatment was dominated when compared with endovascular treatment because these 2 treatments have similar outcomes. The incremental cost-effectiveness ratio of the endovascular group over the surgery group was found to be $4,609.23 per life year gained. The sensitivity analysis showed that the endovascular treatment was found to be cost-effective under willingness to pay $50,000.
  
  
  CONCLUSIONS
  This study provides economic evaluation of ALI treatments for a defined clinical population in the real-world setting. Compared with other available alternatives, the endovascular treatment showed to be a cost-effective use of healthcare resources.
authors: Department of Pharmacy Practice, University of Toledo, Toledo, OH. Electronic address: varun.vaidya@utoledo.edu.
authors: Varun
authors: V
authors: Vaidya
authors: University of Mississippi, Oxford, MS.
authors: Nilesh
authors: N
authors: Gangan
authors: Jobst Vascular Institute of ProMedica Hospitals, Toledo, OH.
authors: Anthony
authors: A
authors: Comerota
authors: Jobst Vascular Institute of ProMedica and Division of Vascular Surgery, University of Michigan, Ann Arbor, MI.
authors: Fedor
authors: F
authors: Lurie
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003661:Decision Support Techniques; D003663:Decision Trees; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D023821:Limb Salvage / Q000191:economics; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data