Objective

Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. non-invasive treatment.

Methods

One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3L™ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits.

Results

The mean cost per patient was €11 060 in the stent group and €4 787 in the control group, resulting in a difference of €6 273 per patient between the groups. The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of € 23 785 per QALY.

Conclusion

The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < €50 000 – €70 000) and approaching the UK’s National Institute for Health and Care Excellence threshold for willingness to pay (ICER < £20 000 – £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.

中文翻译：

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编辑推荐——用于间歇性跛行的股浅动脉初级支架的成本效益：随机多中心试验的两年结果

客观的

间歇性跛行 (IC) 的侵入性治疗通常被执行，尽管其成本效益的证据有限。IC 症状主要由股浅动脉 (SFA) 的动脉粥样硬化病变引起，并且经常进行血管内治疗。本研究的目的是调查其与非侵入性治疗的成本效益。

方法

100 名因 SFA 病变而患有 IC 的患者被随机分配接受初次支架植入、最佳药物治疗 (BMT) 和运动建议治疗（支架组），或仅接受 BMT 和运动建议治疗（对照组）。在瑞典的七家医院招募了患者。为了分析 24 个月后的成本效益，分析了 84 名患者的质量调整生命年数据（QALY；基于 EuroQol 五维 EQ-5D 3L™ 问卷）。患者登记和推算成本数据用于有关住院和门诊就诊的累积成本。

结果

支架组每名患者的平均成本为 11 060 欧元，对照组为 4 787 欧元，导致各组之间的每位患者差异为 6 273 欧元。两组之间平均 QALY 的差异为 0.26，支架组占优势，这导致每个 QALY 的增量成本效益比 (ICER) 为 23 785 欧元。

结论

SFA 中用于治疗 IC 的主要支架植入术的相关费用高于单独的运动建议和 BMT。随着健康相关生活质量的同时改善，根据瑞典国家指南（ICER < 50 000 – 70 000 欧元），初级支架置入术是一种具有成本效益的治疗选择，并接近英国国家健康和护理卓越研究所的意愿阈值支付（ICER < 20 000 英镑 – 30 000 英镑）。从成本效益的角度来看，在许多国家，SFA 的主要支架置入术可以作为运动训练建议的辅助手段，但必须考虑到成功实施结构化运动计划和更长时间的随访可能会改变这些发现。