Is thrombolysis of lower extremity acute arterial occlusion cost-effective ?
Annual Meeting of the Association for Academic Surgery. Seattle, WA, USA, 1998/11/18.
The TOPAS (thrombolysis or peripheral artery surgery) trial randomized 544 patients with acute lower extremity ischemia to either surgery or thrombolysis.
Although statistically equivalent 1-year morbidities and mortalities were demonstrated, the comparative cost-effectiveness of these two interventions has not been explored.
Materials and methods
We constructed a Markov decision-analytic model to determine the cost-effectiveness of thrombolysis relative to surgery for a hypothetical cohort of patients with acute lower extremity arterial occlusion.
Our measure of outcome was the cost-effectiveness ratio (CER), defined as the incremental lifetime cost per quality-adjusted life year gained.
Estimates of 1-year outcomes were based on the TOPAS trial : mortality (lysis, 20% ; surgery, 17%), amputation (lysis, 15% ; surgery, 13%), the number of additional interventions required following the initial procedure (lysis, 544 ; surgery, 439).
Procedural costs were estimated from the cost accounting system at the New York Presbyterian Hospital as well as from the literature.
Operative intervention for acute lower extremity arterial occlusion extended life and was less costly compared to thrombolysis.
The projected life expectancy for patients who underwent initial surgery was 5.04 years versus 4.75 years for initial thrombolysis.
The lifetime costs were $57,429 for surgery versus $76,326 for thrombolysis. (...)
Mots-clés Pascal : Ischémie, Aigu, Extrémité inférieure, Analyse coût efficacité, Etude cohorte, Randomisation, Chirurgie, Lyse, Thrombus, Cathétérisme, Voie abord, Décision Markov, Etude comparative, Homme, Appareil circulatoire pathologie, Economie santé, Traitement instrumental
Mots-clés Pascal anglais : Ischemia, Acute, Lower extremity, Cost efficiency analysis, Cohort study, Randomization, Surgery, Lysis, Thrombus, Catheterization, Surgical approach, Markov decision, Comparative study, Human, Cardiovascular disease, Health economy, Instrumentation therapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0301651
Code Inist : 002B25F. Création : 16/11/1999.