Abstract
Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. non-invasive treatment. One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3L™ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. The mean cost per patient was €11 060 in the stent group and €4 787 in the control group, resulting in a difference of €6 273 per patient between the groups. The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of € 23 785 per QALY. The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < €50 000 - €70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < £20 000 - £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.
Highlights
Peripheral arterial disease (PAD) is a common disease that affects approximately 200 million people worldwide
From a cost effectiveness standpoint, primary stenting of the superficial femoral artery (SFA) can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings
Primary stenting was more expensive than a non-invasive approach, it generated a mean benefit of 0.24 e 0.26 quality adjusted life years (QALY) and a cost effectiveness ratio of about V24 000 e V34 000 per QALY with two years of follow up
Summary
Peripheral arterial disease (PAD) is a common disease that affects approximately 200 million people worldwide. The most common symptomatic presentation is intermittent claudication (IC), affecting 20 e 40 million people worldwide.[1] The economic impact of PAD is substantial,[2] and the global prevalence is increasing.[2]. Management of IC aims to reduce the risk of serious cardiovascular events and to treat the functional walking impairment in order to increase health related quality of life (HRQoL). This is achieved by best medical treatment (BMT) and lifestyle changes such as smoking cessation. SET is often not reimbursed or available for the majority of patients, and simple exercise training advice is the predominating clinical practice.[4]
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