Intermittent Claudication: Cost-effectiveness of Revascularization versus Exercise Therapy

Vries, Sybolt O. de; Visser, Karen; Vries, Jelle A. de; Wong, John B.; Donaldson, Magruder C.; Hunink, M. G. Myriam

doi:10.1148/radiol.2221001743

Cited by 76 publications

(72 citation statements)

References 58 publications

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“…17 The costs of different available treatments, including oral treatment with vasoactive drugs, intensive treatment by intravenous infusion, percutaneous transluminal angioplasty, by-pass surgery and exercise therapy have also been evaluated. 20, 21 Two exercise supervised programs, lasting 6 and 12 months each, showed favorable cost-effectiveness compared to endovascular revascularization or by-pass surgery. 1 Despite its cost-effectiveness, non-invasiveness and the minimal cardiovascular risk, the use of exercise as a treatment option is widespread for PAD.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Patient Compliance, Quality of Life Impact and Cost-Effectiveness of a "Test In-Train Out" Exercise-Based Rehabilitation Program for Patients With Intermittent Claudication

Malagoni

Vagnoni

Felisatti

et al. 2011

Circ J

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Section: Discussionmentioning

confidence: 99%

Evaluation of Patient Compliance, Quality of Life Impact and Cost-Effectiveness of a "Test In-Train Out" Exercise-Based Rehabilitation Program for Patients With Intermittent Claudication

Malagoni

Vagnoni

Felisatti

et al. 2011

Circ J

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“…Rates of procedural mortality and systemic complications are taken from Hunink et al, 77 as previously described. In addition, de Vries et al 78 also include rates for angiographic investigations. For an amputation, mortality rates are presented separately for patients below and above the age of 75 years; rates for systemic complications were assumed not to vary with age.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

“…The only other second-line treatment considered was PTA. This identified a further five economic evaluations (Hunink et al, 77 de Vries et al, 78 Holler et al, 79 Muradin and Myriam Hunink, 80 Visser et al…”

mentioning

confidence: 99%

“…In the first instance, Muradin and Hunink 80 use the model of Hunink et al 77 to look at the cost-effective price required for a hypothetical new endovascular device. In the second instance, Visser et al 81 extended the economic evaluation of de Vries et al 78 to include diagnostic imaging. In both instances the extended evaluations are not of relevance to this study and thus only the original evaluation is considered.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis

Simpson

Kearns

Stevenson

et al. 2014

Health Technology Assessment

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“…49 Cost-effectiveness and quality-of-life outcomes favor the performance of percutaneous therapy whenever feasible as a more effective treatment than exercise alone. 50 A matched-cohort study of 526 patients with intermittent claudication found significant advantages for a revascularization strategy (surgery or PTA) compared with medical therapy. 51 Revascularization was more effective than medical therapy for improvement in physical function, bodily pain, and walking distance.…”

Section: Sfa and Popliteal Artery Diseasementioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD. Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...

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Intermittent Claudication: Cost-effectiveness of Revascularization versus Exercise Therapy

Cited by 76 publications

References 58 publications

Evaluation of Patient Compliance, Quality of Life Impact and Cost-Effectiveness of a "Test In-Train Out" Exercise-Based Rehabilitation Program for Patients With Intermittent Claudication

Evaluation of Patient Compliance, Quality of Life Impact and Cost-Effectiveness of a "Test In-Train Out" Exercise-Based Rehabilitation Program for Patients With Intermittent Claudication

Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis

Endovascular Therapies for Peripheral Arterial Disease

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