Ngu Natalie Ly, Lisik James, Varma Dinesh, Goh Gerard S
Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, Monash University, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2018 Jun;62(3):337-344. doi: 10.1111/1754-9485.12696. Epub 2018 Jan 5.
Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital-related costs of PTA and BYP for PAD of the lower limbs in an Australian health service.
A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed. Patient cohorts were matched to existing published studies and 3-year findings were calculated. Outcomes measured were mean initial admission cost; mean bed stay; mean complication rate; mean cost of re-intervention at 12 months and extrapolated mean cost at 3 years.
The mean total admission costs for PTA compared to BYP were $8758 vs. $27,849 (P < 0.001). Patients undergoing BYP were admitted for 10.25 vs. 3.77 nights (P < 0.001). The complication rate was greater in the BYP group for infection only. Re-intervention was required by 13% of the PTA group and 16% of the BYP group, at a mean cost of $11,798 and $14,728, respectively (P = 0.453). The extrapolated total mean cost at 3 years was higher in the BYP group for patients with both intermittent claudication ($26,764 vs. $11,402) and critical limb ischaemia ($27,719 vs. $12,655).
In this cohort, PTA is a favourable alternative to BYP for PAD of the lower limbs as it is less costly, does not result in a greater re-intervention rate at 1 year and has been previously demonstrated to have comparable clinical outcomes. Given the limitations of this retrospective analysis, a prospective cost-effectiveness analysis is recommended.
经皮腔内血管成形术（PTA）和外科搭桥术（BYP）是有症状外周动脉疾病（PAD）的治疗选择。PTA和BYP有不同的临床结果和成本影响。本文旨在比较澳大利亚一家医疗服务机构中PTA和BYP治疗下肢PAD的医院相关成本。
利用一家城市三级医院的临床和财务数据进行回顾性成本分析。将患者队列与现有已发表研究进行匹配，并计算3年的结果。测量的结果包括平均首次住院成本；平均住院天数；平均并发症发生率；12个月时再次干预的平均成本以及3年时推算的平均成本。
与BYP相比，PTA的平均总住院成本分别为8758美元和27849美元（P < 0.001）。接受BYP的患者住院10.25晚，而PTA患者住院3.77晚（P < 0.001）。仅在感染方面，BYP组的并发症发生率更高。PTA组13%的患者和BYP组16%的患者需要再次干预，平均成本分别为11798美元和14728美元（P = 0.453）。对于间歇性跛行患者和严重肢体缺血患者，BYP组3年时推算的总平均成本更高（分别为26764美元对11402美元和27719美元对12655美元）。
在该队列中，对于下肢PAD，PTA是比BYP更有利的选择，因为它成本更低，1年时不会导致更高的再次干预率，并且先前已证明具有可比的临床结果。鉴于这项回顾性分析的局限性，建议进行前瞻性成本效益分析。
