Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA.
J Med Econ. 2021 Jan-Dec;24(1):570-580. doi: 10.1080/13696998.2021.1917141.
Multiple studies have demonstrated the high economic burden related to the management of lower extremity peripheral artery disease (PAD). This is the first study to examine long-term PAD-related costs among unselected patients undergoing endovascular intervention, and to investigate how clinical and anatomic factors impact cost outcomes over time.
We performed a prospective health economic study alongside the LIBERTY 360° trial (ClinicalTrials.gov; identifier NCT01855412) - a prospective, multi-center study evaluating the long-term outcomes of endovascular revascularization to treat claudication or critical limb ischemia. Costs (2018) were calculated using a combination of standard "bottom-up" cost accounting methods (for index procedures), itemized hospital charges and department level cost-to-charge ratios (for non-procedural hospital resources), national Medicare Severity-Diagnosis Related Group-specific average reimbursements (for follow-up hospitalizations) and Medicare payments (for outpatient/chronic care). Methods for the analysis of censored cost data were used to adjust cost estimates for patients with incomplete follow-up. Independent predictors of cumulative 2-year costs were explored using generalized linear models. A total of 1,189 patients were included (500 Rutherford 2-3, 589 Rutherford 4-5, 100 Rutherford 6). Mean total costs associated with the index procedure hospitalization increased with Rutherford classification ($10,304, $11,418, and $19,403 for Rutherford 2-3, 4-5, and 6, respectively; < 0.01 in all pairwise comparisons). Mean total 2-year follow-up costs were $11,416, $24,846, and $25,720 for Rutherford 2-3, 4-5, and 6, respectively ( < 0.001 comparing Rutherford 2-3 to the other 2 groups; = 0.09 comparing Rutherford 4-5 and Rutherford 6). Key predictors of higher cumulative 2-year costs included female sex, pedal lesion location, severe lesion calcification, the presence of one or more chronic total occlusions, the number of wounds present on the target limb at baseline, and Rutherford classification.
Among patients with symptomatic lower extremity PAD undergoing endovascular revascularization, initial treatment costs and total 2-year costs vary significantly according to clinical and lesion-level characteristics, as well as symptom burden.
多项研究表明，下肢外周动脉疾病（PAD）管理相关的经济负担很高。这是第一项研究，旨在检查接受血管内介入治疗的未选择患者的长期 PAD 相关成本，并探讨临床和解剖因素如何随时间影响成本结果。
我们与 LIBERTY 360°试验（ClinicalTrials.gov；标识符 NCT01855412）一起进行了一项前瞻性健康经济学研究 - 一项前瞻性、多中心研究，评估血管内血运重建治疗跛行或严重肢体缺血的长期结果。使用标准的“自下而上”成本核算方法（用于索引程序）、逐项医院收费和部门级别成本与收费比率（用于非程序医院资源）、国家医疗保险严重程度-诊断相关组特定平均报销额（用于随访住院）和医疗保险支付（用于门诊/慢性护理）计算了 2018 年的成本。使用 censored 成本数据的分析方法调整了随访不完整患者的成本估计。使用广义线性模型探索了累积 2 年成本的独立预测因素。共纳入 1189 例患者（Rutherford 2-3 级 500 例，Rutherford 4-5 级 589 例，Rutherford 6 级 100 例）。与索引程序住院相关的总费用随着 Rutherford 分类而增加（Rutherford 2-3、4-5 和 6 级分别为 10304、11418 和 19403 美元；所有两两比较均<0.01）。Rutherford 2-3、4-5 和 6 级患者的 2 年随访总成本分别为 11416、24846 和 25720 美元（Rutherford 2-3 级与其他 2 组比较差异有统计学意义；Rutherford 4-5 级与 Rutherford 6 级比较差异无统计学意义；=0.09）。累积 2 年成本较高的主要预测因素包括女性、足部病变部位、严重病变钙化、存在一个或多个慢性完全闭塞、目标肢体在基线时存在的伤口数量以及 Rutherford 分类。
在接受血管内血运重建治疗的有症状下肢 PAD 患者中，根据临床和病变特征以及症状负担，初始治疗成本和总 2 年成本差异显著。
