Maastricht University Medical Center, Department of Clinical Epidemiology and Medical Technology Assessment, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2011 Jan;41(1):97-103. doi: 10.1016/j.ejvs.2010.06.024. Epub 2010 Dec 14.
The Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study has shown supervised exercise therapy (SET) to be more effective regarding walking distance and quality of life than a 'go home and walk' advice (WA) for patients with intermittent claudication. The present study aims to assess the cost-effectiveness of SET versus WA.
Data from the EXITPAD study, a 12-month randomised controlled trial in 304 patients with claudication, was used to study the proportion of costs to walking distance and quality of life. Two different incremental cost-effectiveness ratios (ICERs) were calculated for SET versus WA: costs per extra metre on the treadmill test, and costs per quality-adjusted life year (QALY). QALYs were based on utilities derived from the EuroQoL-5 dimensions (EQ-5D).
Mean total costs were higher for SET than for WA (3407 versus 2304 Euros), mainly caused by the costs of exercise therapy. The median walking distance was 620 m for SET and 400 m for WA. QALYs were 0.71 for SET and 0.67 for WA. All differences were statistically significant. The ICER for cost per extra metre on the 12-month treadmill test was € 4.08. For cost per QALY, the ICER was € 28,693.
At a willingness-to-pay threshold of € 40,000 per QALY, SET likely is a cost-effective therapeutic option for patients with claudication.
EXPERT 研究表明，与“回家散步”建议（WA）相比，间歇跛行患者的监督运动疗法（SET）在步行距离和生活质量方面更有效。本研究旨在评估 SET 与 WA 的成本效益。
使用来自 EXPERT 研究的数据，这是一项针对 304 名间歇性跛行患者的为期 12 个月的随机对照试验，研究了步行距离和生活质量的成本比例。为 SET 与 WA 计算了两种不同的增量成本效益比（ICER）：跑步机测试每米额外成本和每质量调整生命年（QALY）的成本。QALYs 基于 EuroQoL-5 维度（EQ-5D）得出的效用。
SET 的总费用高于 WA（3407 欧元对 2304 欧元），主要是由于运动疗法的费用。SET 的中位步行距离为 620 米，WA 为 400 米。SET 的 QALY 为 0.71，WA 为 0.67。所有差异均具有统计学意义。12 个月跑步机测试的每米成本增量的 ICER 为 408 欧元。对于每 QALY 的成本，ICER 为 28693 欧元。
在每 QALY 40000 欧元的支付意愿阈值下，SET 可能是跛行患者的一种具有成本效益的治疗选择。
