Compared with wound care alone or primary amputation, revascularization and limb preservation attempts may be less costly and provide more health benefits, even among patients with marginal functional status at baseline, according to study results published recently in the Annals of Vascular Surgery.
Using a probabilistic Markov model, researchers stimulated the clinical outcomes, health utilities and costs over 10 years with various management strategies. Researchers obtained parameter estimates from previous clinical trials and large observational series, while cost estimates were obtained from cost literature and also a single-center study that reviewed total costs accumulated, including secondary amputations, wound care, outpatient nursing care and nursing home costs. The primary measure of cost-effectiveness included cost per year of ambulation with limb preservation or with a prosthesis after amputation.
Overall, the total 10-year costs of either endovascular or surgical revascularization were lower than the costs of either primary amputation or local wound care alone, according to study results. Researchers also found revascularization strategies provided more health benefits when measured in years or ambulatory ability, years of limb salvage or quality-adjusted life-years. Primary amputation did not prove to be cost effective in any of the scenarios modeled in deterministic sensitivity analyses.
For more information:
Barshes NR. Ann Vasc Surg. 2014; doi.org/10.1016/j.avsg.2013.08.004.