Klomp H M, Steyerberg E W, van Urk H, Habbema J D F
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2006 May;31(5):500-8. doi: 10.1016/j.ejvs.2005.11.013. Epub 2006 Jan 4.
To quantify the costs of treatment in critical limb ischaemia (CLI) and to compare costs and effectiveness of two treatment strategies: spinal cord stimulation (SCS) and best medical treatment.
One hundred and twenty patients with CLI not suitable for vascular reconstruction were randomised to either SCS in addition to best medical treatment or best medical treatment alone. Primary outcomes were mortality, amputation and cost. Cost analysis was based on resources used by patients for 2 years after randomisation. Both medical and non-medical costs were included.
Patient and limb survival were similar in the two treatment groups. Costs of in-hospital-stay and institutional rehabilitation constituted the predominant part (+/-70%) of the total costs of medical care in CLI. Cost of SCS-implantation and complications (7950 euro per patient) exceeded by far cost due to amputation procedures (410 euro per patient). The total costs of treatment were 36,600 euro per patient over 2 years for the SCS-group vs. 28,700 euro for best medical treatment alone (28% higher for SCS-group, p=0.009).
Total costs of treatment in CLI are high. Major components are hospital and rehabilitation costs. In contrast to recent reviews, there were no long-term benefits of SCS-treatment. Therefore, cost-effectiveness is reduced to cost-minimisation and SCS-treatment is considerably more expensive than best medical treatment.
量化严重肢体缺血（CLI）的治疗成本，并比较两种治疗策略的成本和效果：脊髓刺激（SCS）和最佳药物治疗。
120例不适合血管重建的CLI患者被随机分为两组，一组在最佳药物治疗基础上加用SCS，另一组仅接受最佳药物治疗。主要结局指标为死亡率、截肢率和成本。成本分析基于患者随机分组后2年所使用的资源。医疗和非医疗成本均包括在内。
两个治疗组的患者和肢体存活率相似。住院和机构康复成本占CLI医疗总费用的主要部分（约70%）。SCS植入及并发症的成本（每位患者7950欧元）远远超过截肢手术的成本（每位患者410欧元）。SCS组2年的治疗总费用为每位患者36,600欧元，而仅接受最佳药物治疗组为28,700欧元（SCS组高28%，p = 0.009）。
CLI的治疗总成本很高。主要组成部分是医院和康复成本。与近期综述不同，SCS治疗没有长期益处。因此，成本效益降低为成本最小化，且SCS治疗比最佳药物治疗昂贵得多。
