Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication

Autor: M.M.L. van den Houten, Hugo J.P. Fokkenrood, M. G. Myriam Hunink, A. D. I. van Asselt, Joep A.W. Teijink, Farzin Fakhry, Gert Jan Lauret
Přispěvatelé: MUMC+: MA AIOS Heelkunde (9), Promovendi PHPC, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, RS: CAPHRI - R2 - Creating Value-Based Health Care, Epidemiology, Radiology & Nuclear Medicine, PharmacoTherapy, -Epidemiology and -Economics, Value, Affordability and Sustainability (VALUE)
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Cost effectiveness
SURGERY
medicine.medical_treatment
Cost-Benefit Analysis
Health Status
Walking
030204 cardiovascular system & hematology
030230 surgery
Revascularization
law.invention
03 medical and health sciences
0302 clinical medicine
Quality of life
Randomized controlled trial
law
Cost Savings
medicine
CRITICAL LIMB ISCHEMIA
MANAGEMENT
Humans
LOWER-EXTREMITY
OCCLUSIVE DISEASE
Aged
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY
OUTCOMES
business.industry
PERIPHERAL ARTERIAL-DISEASE
Endovascular Procedures
Critical limb ischemia
Intermittent Claudication
Middle Aged
Intermittent claudication
Quality-adjusted life year
Exercise Therapy
RANDOMIZED CLINICAL-TRIAL
PRACTICE GUIDELINES
Cohort
Reperfusion
Physical therapy
Quality of Life
Female
Quality-Adjusted Life Years
medicine.symptom
business
Zdroj: British Journal of Surgery, 103(12), 1616-1625. Wiley
British Journal of Surgery, 103(12), 1616-1625. John Wiley & Sons Ltd.
ISSN: 0007-1323
Popis: Background Current guidelines recommend supervised exercise therapy (SET) as the preferred initial treatment for patients with intermittent claudication. The availability of SET programmes is, however, limited and such programmes are often not reimbursed. Evidence for the long-term cost-effectiveness of SET compared with endovascular revascularization (ER) as primary treatment for intermittent claudication might aid widespread adoption in clinical practice. Methods A Markov model was constructed to determine the incremental costs, incremental quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio of SETversus ER for a hypothetical cohort of patients with newly diagnosed intermittent claudication, from the Dutch healthcare payer's perspective. In the event of primary treatment failure, possible secondary interventions were repeat ER, open revascularization or major amputation. Data sources for model parameters included original data from two RCTs, as well as evidence from the medical literature. The robustness of the results was tested with probabilistic and one-way sensitivity analysis. Results Considering a 5-year time horizon, probabilistic sensitivity analysis revealed that SET was associated with cost savings compared with ER (−€6412, 95 per cent credibility interval (CrI) –€11 874 to –€1939). The mean difference in effectiveness was −0·07 (95 per cent CrI −0·27 to 0·16) QALYs. ER was associated with an additional €91 600 per QALY gained compared with SET. One-way sensitivity analysis indicated more favourable cost-effectiveness for ER in subsets of patients with low quality-of-life scores at baseline. Conclusion SET is a more cost-effective primary treatment for intermittent claudication than ER. These results support implementation of supervised exercise programmes in clinical practice.
Databáze: OpenAIRE
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