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Cost Determinants of Percutaneous and Surgical Interventions for Treatment of Intermittent Claudication from the Perspective of the Hospital

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Abstract

Purpose

To identify pretreatment predictors of procedural costs in percutaneous and surgical interventions for intermittent claudication due to aortoiliac and/or femoropopliteal disease.

Methods

A retrospective study was conducted in 97 consecutive patients who underwent percutaneous or surgical interventions over 15 months at a tertiary care center. Nineteen clinical predictive variables were collected at baseline. Procedural costs (outcome) were assessed from the perspective of the hospital by direct calculation, not based on ratios of costs-to-charges. A multivariable regression model was built to identify significant cost predictors. Follow-up information was obtained to provide multidimensional assessment of clinical outcome, including technical success (arteriographic score) and clinical result (changes in ankle-brachial pressure index; cumulative patency, mortality, and complication rates).

Results

The linear regression model shows that procedural costs per patient are 25% lower in percutaneous patients (versus surgical), 42% lower for patients without rest pain than for those with, 28% lower if treated lesions are unilateral (versus bilateral), 12% lower if the treated lesion is stenotic rather than occlusive, 34% higher in sedentary patients, and 11% higher in patients with a history of cardiac disease. After a mean clinical follow-up >2 years, between-group differences between percutaneous and surgical patients were small and of limited significance in all dimensions of clinical outcome.

Conclusion

Predictors of clinical outcome are different from predictors of costs, and one should include both types of variables in the decision-making process. The choice of percutaneous versus surgical strategy, the presence of rest pain, and the bilaterality of the culprit lesions were the main pretreatment determinants of procedural costs. When possible choices of treatment strategy overlap, percutaneous treatment should provide an acceptable result that is less expensive (although not equal to surgery).

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References

  1. Hunink MG, Cullen KA, Donaldson MC (1994) Hospital costs of revascularization procedures for femoropopliteal arterial disease. J Vasc Surg 19:632–641

    PubMed  CAS  Google Scholar 

  2. Dormandy JA, Rutherford RB (2000) Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 31:S1–S296

    Article  PubMed  CAS  Google Scholar 

  3. Janne d’Othée B, Langdon DR, Bell GK, Bettmann MA (2006) Operating expenses for the diagnosis and treatment of peripheral vascular disease in an academic interventional radiology department: Cost calculations according to a microeconomic method. J Vasc Interv Radiol 17:85–94

    Article  PubMed  Google Scholar 

  4. Hoch JS, Briggs AH, Willan AR (2002) Something old, something new, something borrowed, something blue: A framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ 11:415–430

    Article  PubMed  Google Scholar 

  5. Dacey LJ, Dow RW, McDaniel MD, Walsh DB, Zwolak RM, Cronenwett JL (1988) Cost-effectiveness of intra-arterial thrombolytic therapy. Arch Surg 123:1218–1223

    PubMed  CAS  Google Scholar 

  6. Rutherford RB, Baker JD, Ernst C, et al (1997) Recommended standards for reports dealing with lower extremity ischemia: Revised version. J Vasc Surg 26:517–538

    Article  PubMed  CAS  Google Scholar 

  7. Jansen RM, de Vries SO, Cullen KA, Donaldson MC, Hunink MG (1998) Cost-identification analysis of revascularization procedures on patients with peripheral arterial occlusive disease. J Vasc Surg 28:617–623

    Article  PubMed  CAS  Google Scholar 

  8. Doubilet P, Abrams HL (1984) The cost of underutilization. Percutaneous transluminal angioplasty for peripheral vascular disease. N Engl J Med 310:95–102

    Article  PubMed  CAS  Google Scholar 

  9. Bolia A (1998) Percutaneous intentional extraluminal (subintimal) recanalization of crural arteries. Eur J Radiol 28:199–204

    Article  PubMed  CAS  Google Scholar 

  10. Spinosa DJ, Leung DA, Harthun NL, et al (2003) Simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. J Vasc Interv Radiol 14:1449–1454

    PubMed  Google Scholar 

  11. Treiman GS, Whiting JH, Treiman RL, McNamara RM, Ashrafi A (2003) Treatment of limb-threatening ischemia with percutaneous intentional extraluminal recanalization: A preliminary evaluation. J Vasc Surg 38:29–35

    Article  PubMed  Google Scholar 

  12. Sheiman RG, Janne d’Othée BJ (2007) Screening carotid sonography before elective coronary artery bypass graft surgery: Who needs it? AJR Am J Roentgenol 188:W475–479

    Article  PubMed  Google Scholar 

  13. Currie IC, Wilson YG, Baird RN, Lamont PM (1995) Treatment of intermittent claudication: The impact on quality of life. Eur J Vasc Endovasc Surg 10:356–361

    Article  PubMed  CAS  Google Scholar 

  14. Khaira HS, Hanger R, Shearman CP (1996) Quality of life in patients with intermittent claudication. Eur J Vasc Endovasc Surg 11:65–69

    Article  PubMed  CAS  Google Scholar 

  15. Whyman MR, Fowkes FG, Kerracher EM, et al (1997) Is intermittent claudication improved by percutaneous transluminal angioplasty? A randomized controlled trial. J Vasc Surg 26:551–557

    Article  PubMed  CAS  Google Scholar 

  16. Zannetti S, L’Italien GJ, Cambria RP (1996) Functional outcome after surgical treatment for intermittent claudication. J Vasc Surg 24:65–73

    Article  PubMed  CAS  Google Scholar 

  17. Weinstein MC, Stason WB (1982) Cost-effectiveness of coronary artery bypass surgery. Circulation 66:III56–66

    PubMed  CAS  Google Scholar 

  18. Albers M, Fratezi AC, De Luccia N (1996) Walking ability and quality of life as outcome measures in a comparison of arterial reconstruction and leg amputation for the treatment of vascular disease. Eur J Vasc Endovasc Surg 11:308–314

    Article  PubMed  CAS  Google Scholar 

  19. Gibbons GW, Burgess AM, Guadagnoli E, et al (1995) Return to well-being and function after infrainguinal revascularization. J Vasc Surg 21:35–44; discussion 44–45

    Article  PubMed  CAS  Google Scholar 

  20. Jenkinson C, Gray A, Doll H, Lawrence K, Keoghane S, Layte R (1997) Evaluation of index and profile measures of health status in a randomized controlled trial. Comparison of the Medical Outcomes Study 36-Item Short Form Health Survey, EuroQol, and disease specific measures. Med Care 35:1109–1118

    Article  PubMed  CAS  Google Scholar 

  21. Pell JP (1995) Impact of intermittent claudication on quality of life. The Scottish Vascular Audit Group. Eur J Vasc Endovasc Surg 9:469–472

    Article  PubMed  CAS  Google Scholar 

  22. Dorman P, Slattery J, Farrell B, Dennis M, Sandercock P (1998) Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. Stroke 29:63–68

    PubMed  CAS  Google Scholar 

  23. Busschbach JJ, McDonnell J, Tangelder MJ, et al (1999) EuroQol values for economic modeling quality of life after infrainguinal bypass grafting surgery: a rectification. J Vasc Surg 30:1162–1163

    PubMed  CAS  Google Scholar 

  24. Hiatt WR (1997) Quality of life assessment in peripheral arterial disease. Atherosclerosis 131(Suppl):S35–36

    Article  PubMed  CAS  Google Scholar 

  25. Meltzer D, Johannesson M (1999) Inconsistencies in the “societal perspective” on costs of the Panel on Cost-Effectiveness in Health and Medicine. Med Decis Making 19:371–377

    Article  PubMed  CAS  Google Scholar 

  26. Powe NR (1994) Economic and cost-effectiveness investigations of radiologic practices. Radiology 192:11–18

    PubMed  CAS  Google Scholar 

  27. Powe NR (1995) Cost-effectiveness analyses. N Engl J Med 332:123–124; discussion 124–125

    Article  PubMed  CAS  Google Scholar 

  28. Janne d’Othée B, Faintuch S, Reedy AW, Nickerson CF, Rosen MP (2008) Retrievable versus permanent caval filter procedures: When are they cost-effective for Interventional Radiology? J Vasc Interv Radiol: in press

  29. Huber TS, Seeger JM (2001) Dartmouth Atlas of Vascular Health Care review: Impact of hospital volume, surgeon volume, and training on outcome. J Vasc Surg 34:751–756

    Article  PubMed  CAS  Google Scholar 

  30. Dartmouth Medical School CfECS (2000) The Dartmouth Atlas of Vascular Health Care. AHA Press, Health Forum, Chicago

    Google Scholar 

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Acknowledgments

The authors thank their patients who filled the quality-of-life questionnaires, and Shirley A. Henry and Charles H. Allen for their help in collecting cost data. The insightful help of Jeffrey Hoch, PhD, was also greatly appreciated during preparation of the manuscript. Bertrand Janne d’Othée was supported by a Research Grant from the French Society of Radiology (Société Française de Radiologie) and by Dartmouth College.

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Authors and Affiliations

  1. Department of Radiology, Cardiovascular Imaging & Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street – GRB-290, Boston, 02114-2696, USA

    Bertrand Janne d’Othée

  2. Banner Good Samaritan Hospital, 1111 E. McDowell Road, Phoenix, AZ, 85006, USA

    Michael F. Morris

  3. Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA

    Richard J. Powell

  4. Department of Radiological Science, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Michael A. Bettmann

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  1. Bertrand Janne d’Othée
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  2. Michael F. Morris
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  4. Michael A. Bettmann
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Correspondence to Bertrand Janne d’Othée.

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Janne d’Othée, B., Morris, M.F., Powell, R.J. et al. Cost Determinants of Percutaneous and Surgical Interventions for Treatment of Intermittent Claudication from the Perspective of the Hospital. Cardiovasc Intervent Radiol 31, 56–65 (2008). https://doi.org/10.1007/s00270-007-9221-4

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  • DOI: https://doi.org/10.1007/s00270-007-9221-4

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