The choice of strategy in the treatment of intermittent claudication--a decision tree approach.

OBJECTIVES

to compare possible outcomes of the non-operative treatment for intermittent claudication with that of surgery.

DESIGN

decision tree approach using published and vascular registry data. The valuation of clinical outcomes was estimated by index weights using the Rosser index and the Quality of Well-Being scale.

SETTING

routine health care in Sweden.

MATERIALS

published data on 224 non-operatively treated claudicants and data from 805 claudicants treated with surgery or angioplasty from the Swedvasc registry. No diabetics were included. Chief outcome measure: expected utility value at one year after decision on treatment given the clinical data and the estimated health status valuations.

MAIN RESULTS

it was possible to identify a success rate for surgery above which it was the better alternative. However, depending on which of two health indices that was used, and if reconstruction was supra- or infrainguinal, this threshold value varied from 0-81%.

CONCLUSIONS

reliable measures of the value of outcomes have to be developed and, in addition, long-term data on outcome and costs in routine care have to be collected before a comprehensive economic assessment based on the decision tree approach can be made to support decisions on treatment for intermittent claudication.