Cost-effectiveness of the treatments for critical limb ischemia in the elderly population

C.M.L. Peters*, J. de Vries, S. Redeker, R. Timman, G.J. van Eijck, S L Steunenberg, N. Verbogt, G.H. Ho, J.J. van Busschbach, L. van der Laan

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective
The treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.


Methods
In this prospective observational cohort study, data were gathered in two Dutch peripheral hospitals. CLI patients aged 70 years or older were included in the outpatient clinic. Exclusion criteria were malignant disease, lack of language skills, and cognitive impairment; 195 patients were included and 192 patients were excluded. After a multidisciplinary vascular conference, patients were divided into three treatment groups (endovascular revascularization, surgical revascularization, or conservative therapy). Subanalyses based on age were made (70-79 years and ≥80 years). The follow-up period was 2 years. Cost-effectiveness of endovascular and conservative treatment was quantified using incremental cost-effectiveness ratios (ICERs) in euros per quality-adjusted life-years (QALYs).


Results
At baseline, patients allocated to surgical revascularization had better health states, but the health states of endovascular revascularization and conservative therapy patients were comparable. With an ICER of €38,247.41/QALY (∼$50,869/QALY), endovascular revascularization was cost-effective compared with conservative therapy. This is favorable compared with the Dutch applicable threshold of €80,000/QALY (∼$106,400/QALY). The subanalyses also established that endovascular revascularization is a cost-effective alternative for conservative treatment both in patients aged 70 to 79 years (ICER €29,898.36/QALY; ∼$39,765/QALY) and in octogenarians (ICER €56,810.14/QALY; ∼$75,557/QALY).


Conclusions
Our study has shown that endovascular revascularization is cost-effective compared with conservative treatment of CLI patients older than 70 years and also in octogenarians. Given the small absolute differences in costs and effects, physicians should also consider individual circumstances that can alter the outcome of the intervention. Cost-effectiveness remains one of the aspects to take into consideration in making a clinical decision.
Original languageEnglish
Pages (from-to)530-538
JournalJournal of Vascular Surgery
Volume70
Issue number2
DOIs
Publication statusPublished - 2019

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Quality-Adjusted Life Years
Cost-Benefit Analysis
Ambulatory Care Facilities
Conservative Treatment
Language
Physicians

Keywords

  • ANGIOPLASTY
  • BYPASS
  • Cost-effectiveness
  • Costs
  • Critical limb ischemia
  • Frail elderly
  • HEALTH
  • MORTALITY
  • OCTOGENARIANS
  • QUALITY-OF-LIFE
  • Quality-adjusted life-years
  • REVASCULARIZATION
  • TRIAL

Cite this

Peters, C. M. L., de Vries, J., Redeker, S., Timman, R., van Eijck, G. J., Steunenberg, S. L., ... van der Laan, L. (2019). Cost-effectiveness of the treatments for critical limb ischemia in the elderly population. Journal of Vascular Surgery, 70(2), 530-538. https://doi.org/10.1016/j.jvs.2018.11.042
Peters, C.M.L. ; de Vries, J. ; Redeker, S. ; Timman, R. ; van Eijck, G.J. ; Steunenberg, S L ; Verbogt, N. ; Ho, G.H. ; van Busschbach, J.J. ; van der Laan, L. / Cost-effectiveness of the treatments for critical limb ischemia in the elderly population. In: Journal of Vascular Surgery. 2019 ; Vol. 70, No. 2. pp. 530-538.
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title = "Cost-effectiveness of the treatments for critical limb ischemia in the elderly population",
abstract = "ObjectiveThe treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.MethodsIn this prospective observational cohort study, data were gathered in two Dutch peripheral hospitals. CLI patients aged 70 years or older were included in the outpatient clinic. Exclusion criteria were malignant disease, lack of language skills, and cognitive impairment; 195 patients were included and 192 patients were excluded. After a multidisciplinary vascular conference, patients were divided into three treatment groups (endovascular revascularization, surgical revascularization, or conservative therapy). Subanalyses based on age were made (70-79 years and ≥80 years). The follow-up period was 2 years. Cost-effectiveness of endovascular and conservative treatment was quantified using incremental cost-effectiveness ratios (ICERs) in euros per quality-adjusted life-years (QALYs).ResultsAt baseline, patients allocated to surgical revascularization had better health states, but the health states of endovascular revascularization and conservative therapy patients were comparable. With an ICER of €38,247.41/QALY (∼$50,869/QALY), endovascular revascularization was cost-effective compared with conservative therapy. This is favorable compared with the Dutch applicable threshold of €80,000/QALY (∼$106,400/QALY). The subanalyses also established that endovascular revascularization is a cost-effective alternative for conservative treatment both in patients aged 70 to 79 years (ICER €29,898.36/QALY; ∼$39,765/QALY) and in octogenarians (ICER €56,810.14/QALY; ∼$75,557/QALY).ConclusionsOur study has shown that endovascular revascularization is cost-effective compared with conservative treatment of CLI patients older than 70 years and also in octogenarians. Given the small absolute differences in costs and effects, physicians should also consider individual circumstances that can alter the outcome of the intervention. Cost-effectiveness remains one of the aspects to take into consideration in making a clinical decision.",
keywords = "ANGIOPLASTY, BYPASS, Cost-effectiveness, Costs, Critical limb ischemia, Frail elderly, HEALTH, MORTALITY, OCTOGENARIANS, QUALITY-OF-LIFE, Quality-adjusted life-years, REVASCULARIZATION, TRIAL",
author = "C.M.L. Peters and {de Vries}, J. and S. Redeker and R. Timman and {van Eijck}, G.J. and Steunenberg, {S L} and N. Verbogt and G.H. Ho and {van Busschbach}, J.J. and {van der Laan}, L.",
year = "2019",
doi = "10.1016/j.jvs.2018.11.042",
language = "English",
volume = "70",
pages = "530--538",
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issn = "0741-5214",
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number = "2",

}

Peters, CML, de Vries, J, Redeker, S, Timman, R, van Eijck, GJ, Steunenberg, SL, Verbogt, N, Ho, GH, van Busschbach, JJ & van der Laan, L 2019, 'Cost-effectiveness of the treatments for critical limb ischemia in the elderly population', Journal of Vascular Surgery, vol. 70, no. 2, pp. 530-538. https://doi.org/10.1016/j.jvs.2018.11.042

Cost-effectiveness of the treatments for critical limb ischemia in the elderly population. / Peters, C.M.L.; de Vries, J.; Redeker, S.; Timman, R.; van Eijck, G.J.; Steunenberg, S L; Verbogt, N.; Ho, G.H.; van Busschbach, J.J.; van der Laan, L.

In: Journal of Vascular Surgery, Vol. 70, No. 2, 2019, p. 530-538.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Cost-effectiveness of the treatments for critical limb ischemia in the elderly population

AU - Peters, C.M.L.

AU - de Vries, J.

AU - Redeker, S.

AU - Timman, R.

AU - van Eijck, G.J.

AU - Steunenberg, S L

AU - Verbogt, N.

AU - Ho, G.H.

AU - van Busschbach, J.J.

AU - van der Laan, L.

PY - 2019

Y1 - 2019

N2 - ObjectiveThe treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.MethodsIn this prospective observational cohort study, data were gathered in two Dutch peripheral hospitals. CLI patients aged 70 years or older were included in the outpatient clinic. Exclusion criteria were malignant disease, lack of language skills, and cognitive impairment; 195 patients were included and 192 patients were excluded. After a multidisciplinary vascular conference, patients were divided into three treatment groups (endovascular revascularization, surgical revascularization, or conservative therapy). Subanalyses based on age were made (70-79 years and ≥80 years). The follow-up period was 2 years. Cost-effectiveness of endovascular and conservative treatment was quantified using incremental cost-effectiveness ratios (ICERs) in euros per quality-adjusted life-years (QALYs).ResultsAt baseline, patients allocated to surgical revascularization had better health states, but the health states of endovascular revascularization and conservative therapy patients were comparable. With an ICER of €38,247.41/QALY (∼$50,869/QALY), endovascular revascularization was cost-effective compared with conservative therapy. This is favorable compared with the Dutch applicable threshold of €80,000/QALY (∼$106,400/QALY). The subanalyses also established that endovascular revascularization is a cost-effective alternative for conservative treatment both in patients aged 70 to 79 years (ICER €29,898.36/QALY; ∼$39,765/QALY) and in octogenarians (ICER €56,810.14/QALY; ∼$75,557/QALY).ConclusionsOur study has shown that endovascular revascularization is cost-effective compared with conservative treatment of CLI patients older than 70 years and also in octogenarians. Given the small absolute differences in costs and effects, physicians should also consider individual circumstances that can alter the outcome of the intervention. Cost-effectiveness remains one of the aspects to take into consideration in making a clinical decision.

AB - ObjectiveThe treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.MethodsIn this prospective observational cohort study, data were gathered in two Dutch peripheral hospitals. CLI patients aged 70 years or older were included in the outpatient clinic. Exclusion criteria were malignant disease, lack of language skills, and cognitive impairment; 195 patients were included and 192 patients were excluded. After a multidisciplinary vascular conference, patients were divided into three treatment groups (endovascular revascularization, surgical revascularization, or conservative therapy). Subanalyses based on age were made (70-79 years and ≥80 years). The follow-up period was 2 years. Cost-effectiveness of endovascular and conservative treatment was quantified using incremental cost-effectiveness ratios (ICERs) in euros per quality-adjusted life-years (QALYs).ResultsAt baseline, patients allocated to surgical revascularization had better health states, but the health states of endovascular revascularization and conservative therapy patients were comparable. With an ICER of €38,247.41/QALY (∼$50,869/QALY), endovascular revascularization was cost-effective compared with conservative therapy. This is favorable compared with the Dutch applicable threshold of €80,000/QALY (∼$106,400/QALY). The subanalyses also established that endovascular revascularization is a cost-effective alternative for conservative treatment both in patients aged 70 to 79 years (ICER €29,898.36/QALY; ∼$39,765/QALY) and in octogenarians (ICER €56,810.14/QALY; ∼$75,557/QALY).ConclusionsOur study has shown that endovascular revascularization is cost-effective compared with conservative treatment of CLI patients older than 70 years and also in octogenarians. Given the small absolute differences in costs and effects, physicians should also consider individual circumstances that can alter the outcome of the intervention. Cost-effectiveness remains one of the aspects to take into consideration in making a clinical decision.

KW - ANGIOPLASTY

KW - BYPASS

KW - Cost-effectiveness

KW - Costs

KW - Critical limb ischemia

KW - Frail elderly

KW - HEALTH

KW - MORTALITY

KW - OCTOGENARIANS

KW - QUALITY-OF-LIFE

KW - Quality-adjusted life-years

KW - REVASCULARIZATION

KW - TRIAL

U2 - 10.1016/j.jvs.2018.11.042

DO - 10.1016/j.jvs.2018.11.042

M3 - Article

VL - 70

SP - 530

EP - 538

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -