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Endovascular revascularization for PAD costs less than surgery, primary amputation
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In a retrospective analysis of patients with peripheral artery disease from a single-payer system, endovascular revascularization was associated with fewer costs than open surgery or primary amputation.
The researchers analyzed 1,138 patients admitted to three centers for symptomatic PAD, of whom 1,017 had an endovascular procedure (mean age, 70 years; 35% women), 86 had open surgery (mean age, 70 years; 26% women) and 35 had primary amputation (mean age, 69 years; 26% women). Costs were measured in Australian dollars.
The primary amputation group was more likely to require an emergency procedure (P < .001) and be Rutherford category 5 or 6 (P < .001) than the other groups.
Compared with the other groups, the endovascular group had shorter length of stay (endovascular, 3.4 days; open surgery, 10 days; amputation, 20.2 days; P < .01) and used fewer ICU resources (endovascular, 2.4 hours; open surgery, 22.6 hours; amputation, 54.6 hours; P < .01), Linda Tang, MBBS, MS, from the department of surgery, Prince of Wales Hospital, Sydney, and colleagues wrote.
Mean prosthetic and device costs were highest in the endovascular group (endovascular, AU$2,770; open surgery, AU$1,658; amputation, AU$1,219; P < .01), according to the researchers.
However, after adjustment for confounders, overall costs per admission were lowest in the endovascular group (endovascular, AU$18,396; 95% CI, 16,436-20,356; open surgery, AU$31,908; 95% CI, 28,285-35,530; amputation, AU$43,033; 95% CI, 37,706-48,361). This was driven by operating theater times, length of stay and ICU usage, Tang and colleagues wrote.
“Contemporary endovascular therapy is less expensive than both open revascularization and primary major amputation,” they wrote. “There are increased prosthetic costs associated with endovascular therapy due to the array of new devices that have been designed for endovascular intervention. However, that cost is markedly outweighed by those expenditures associated with length of stay, critical care unit utilization and operating theater time.”
In a related editorial, James H. Black III, MD, from the department of vascular surgery and endovascular therapy, Johns Hopkins Hospital, wrote: “The observation of how health care delivery has changed in the past decade is remarkable. ... I believe advances in antiplatelet management after intervention and better optimal medical management may reduce the readmission rate and the ‘catch-up’ in [length of stay] seen in [the BASIL trial’s] endovascular group over time.” – by Erik Swain
Disclosures: Tang and Black report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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