Neal R. Barshes, MD, MPH, James D

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Presentation transcript:

Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss Neal R. Barshes, MD, MPH, James D. Chambers, PhD, MPharm, MSc, Joshua Cohen, PhD, Michael Belkin, MD Journal of Vascular Surgery Volume 56, Issue 4, Pages 1015-1024.e1 (October 2012) DOI: 10.1016/j.jvs.2012.02.069 Copyright © 2012 Terms and Conditions

Fig 1 Schematic diagram demonstrates an overview of the patient-oriented clinical states modeled in the computer simulation for critical limb ischemia (CLI) management strategies 3 to 6. Journal of Vascular Surgery 2012 56, 1015-1024.e1DOI: (10.1016/j.jvs.2012.02.069) Copyright © 2012 Terms and Conditions

Fig 2 The annual costs per living patient are demonstrated during the 10-year interval after the initiation of various management strategies: (A) strategy 1 (local wound care); (B) strategy 2 (primary amputation); (C) strategy 3 (surgical bypass with surgical revision); (D) strategy 4 (surgical bypass with endovascular revision); (E) strategy 5 (purely endovascular intervention); and (F) strategy 6 (endovascular intervention, surgical bypass for failure). Journal of Vascular Surgery 2012 56, 1015-1024.e1DOI: (10.1016/j.jvs.2012.02.069) Copyright © 2012 Terms and Conditions

Fig 3 The incremental costs (in 2009 U.S. dollars) and incremental benefits (quality-adjusted life-years) are demonstrated for strategy 4 (surgical bypass with endovascular revision) compared with strategy 1 (local wound care with amputation as indicated). Journal of Vascular Surgery 2012 56, 1015-1024.e1DOI: (10.1016/j.jvs.2012.02.069) Copyright © 2012 Terms and Conditions

Fig 4 Cost-effectiveness acceptability curves are shown for critical limb ischemia (CLI) management strategies compared with strategy 1 (local wound care). The probability of strategy 4 (surgical bypass with endovascular revision) being a cost-effective alternative increases as the willingness-to-pay threshold in U.S. dollars (USD) surpasses $39,255 per quality-adjusted life-year. Journal of Vascular Surgery 2012 56, 1015-1024.e1DOI: (10.1016/j.jvs.2012.02.069) Copyright © 2012 Terms and Conditions