We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Revascularization for femoropopliteal disease. A decision and cost-effectiveness analysis.
- Authors
Hunink, M G; Wong, J B; Donaldson, M C; Meyerovitz, M F; de Vries, J; Harrington, D P
- Abstract
<bold>Objective: </bold>To evaluate the relative benefits and cost-effectiveness of revascularization for femoropopliteal disease using percutaneous transluminal angioplasty or bypass surgery.<bold>Design: </bold>Decision analysis using a multistate transition simulation model (Markov process) and cost-effectiveness analysis from the perspective of the health care system.<bold>Setting: </bold>Based on mortality, morbidity, patency, and cost data from a literature review.<bold>Patients: </bold>Hypothetical cohort of patients with chronic femoropopliteal disease who desire revascularization. Subgroup analysis for patients defined by age, sex, indication, lesion type, and graft type.<bold>Interventions: </bold>Percutaneous transluminal angioplasty, bypass surgery, and a strategies combining the two treatments.<bold>Main Outcome Measures: </bold>Five-year patency results, quality-adjusted life expectancy, lifetime costs, and incremental cost-effectiveness ratios.<bold>Results: </bold>For 65-year-old men with disabling claudication and a femoropopliteal stenosis or occlusion and for 65-year-old men with chronic critical ischemia and a femoropopliteal stenosis, initial angioplasty increased quality-adjusted life expectancy by 2 to 13 months and resulted in decreased lifetime expenditures compared with bypass surgery. For patients with chronic critical ischemia and a femoropopliteal occlusion, initial bypass surgery increased quality-adjusted life expectancy by 1 to 4 months and resulted in decreased lifetime expenditures compared with angioplasty. Sensitivity analysis demonstrated that angioplasty would always be the preferred initial treatment if the angioplasty 5-year patency rate exceeds 30%.<bold>Conclusion: </bold>Angioplasty is the preferred initial treatment in patients with disabling claudication and a femoropopliteal stenosis or occlusion and in those with chronic critical ischemia and a stenosis. Bypass surgery is the preferred initial treatment in patients with chronic critical ischemia and a femoropopliteal occlusion.
- Publication
JAMA: Journal of the American Medical Association, 1995, Vol 274, Issue 2, p165
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.274.2.165