Popplewell Matthew A, Andronis Lazaros, Davies Huw O B, Meecham Lewis, Kelly Lisa, Bate Gareth, Bradbury Andrew W
University of Birmingham Department of Vascular Surgery, Netherwood House, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Population Evidence and Technologies, Warwick Medical School, University of Warwick, Warwick, United Kingdom.
J Vasc Surg. 2022 Jan;75(1):195-204. doi: 10.1016/j.jvs.2021.07.232. Epub 2021 Sep 3.
Chronic limb-threatening ischemia (CLTI) is a growing global problem due to the widespread use of tobacco and increasing prevalence of diabetes. Although the financial consequences are considerable, few studies have compared the relative cost-effectiveness of different CLTI management strategies. The Bypass vs Angioplasty in Severe Ischaemia of the Leg (BASIL)-2 trial is randomizing patients with CLTI to primary infrapopliteal (IP) vein bypass surgery (BS) or best endovascular treatment (BET) and includes a comprehensive within-trial cost-utility analysis. The aim of this study is to compare over a 12-month time horizon, the costs of primary IP BS, IP best endovascular treatment (BET), and major limb major amputation (MLLA) to inform the BASIL-2 cost-utility analysis.
We compared procedural human resource (HR) costs and total in-hospital costs for the index admission, and over the following 12-months, in 60 consecutive patients undergoing primary IP BS (n = 20), IP BET (n = 20), or MLLA (10 transfemoral and 10 transtibial) for CLTI within the BASIL prospective cohort study.
Procedural HR costs were greatest for BS (BS £2551; 95% confidence interval [CI], £1934-£2807 vs MLLA £1130; 95% CI, £1046-£1297 vs BET £329; 95% CI, £242-£390; P < .001, Kruskal-Wallis) due to longer procedure duration and greater staff requirement. With regard to the index admission, MLLA was the most expensive due to longer hospital stay (MLLA £13,320; 95% CI, £8986-£18,616 vs BS £8714; 95% CI, £6097-£11,973 vs BET £4813; 95% CI, £3529-£6097; P < .001, Kruskal-Wallis). The total cost of the index admission and in-hospital care over the following 12 months remained least for BET (MLLA £26,327; 95% CI, £17,653-£30,458 vs BS £20,401; 95% CI, £12,071-£23,926 vs BET £12,298; 95% CI, £6961-£15,439; P < .001, Kruskal-Wallis).
Over a 12-month time horizon, MLLA and IP BS are more expensive than IP BET in terms of procedural HR costs and total in-hospital costs. These economic data, together with quality of life data from BASIL-2, will inform the calculation of incremental cost-effectiveness ratios for different CLTI management strategies within the BASIL-2 cost-utility analysis.
由于烟草的广泛使用和糖尿病患病率的上升，慢性肢体威胁性缺血（CLTI）已成为一个日益严重的全球性问题。尽管其经济后果相当严重，但很少有研究比较不同CLTI管理策略的相对成本效益。腿部严重缺血的旁路手术与血管成形术（BASIL）-2试验正在将CLTI患者随机分为原发性腘下（IP）静脉旁路手术（BS）或最佳血管内治疗（BET），并包括一项全面的试验内成本效用分析。本研究的目的是在12个月的时间范围内，比较原发性IP BS、IP最佳血管内治疗（BET）和大肢体大截肢（MLLA）的成本，以为BASIL-2成本效用分析提供参考。
在BASIL前瞻性队列研究中，我们比较了60例接受原发性IP BS（n = 20）、IP BET（n = 20）或MLLA（10例经股截肢和10例经胫截肢）治疗CLTI的连续患者的首次住院手术人力资源（HR）成本和总住院成本，以及接下来12个月的成本。
由于手术时间较长和对工作人员的需求较大，BS的手术HR成本最高（BS为2551英镑；95%置信区间[CI]，1934 - 2807英镑，而MLLA为1130英镑；95% CI，1046 - 1297英镑，BET为329英镑；95% CI，242 - 390英镑；P <.001，Kruskal-Wallis检验）。就首次住院而言，由于住院时间较长，MLLA最为昂贵（MLLA为13320英镑；95% CI，8986 - 18616英镑，而BS为8714英镑；95% CI，6097 - 11973英镑，BET为4813英镑；95% CI，3529 - 6097英镑；P <.001，Kruskal-Wallis检验）。首次住院和接下来12个月的住院护理总成本，BET仍然最低（MLLA为26327英镑；95% CI，17653 - 30458英镑，而BS为20401英镑；95% CI，12071 - 23926英镑，BET为12298英镑；95% CI，6961 - 15439英镑；P <.001，Kruskal-Wallis检验）。
在12个月的时间范围内，就手术HR成本和总住院成本而言，MLLA和IP BS比IP BET更昂贵。这些经济数据，连同BASIL-2的生活质量数据，将为BASIL-2成本效用分析中不同CLTI管理策略的增量成本效益比计算提供参考。
