Cost-Effectiveness of Endovascular vs Open Surgery for Chronic Limb-Threatening Ischemia.
Bypass surgery had a 93% chance of being more cost-effective than endovascular therapy.
Cost-Effectiveness of Endovascular vs Open Surgery for Chronic Limb-Threatening Ischemia.
IMPORTANCE: Choosing between endovascular and open (bypass) surgical revascularization for chronic limb-threatening ischemia has major implications for clinical practice.
To evaluate the cost-effectiveness of endovascular vs bypass surgical revascularization.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used individual-level data from the Best Endovascular vs Best Surgical Therapy for Patients With Chronic Limb Ischemia (BEST-CLI) trial, with the first patient enrolled August 28, 2014, and the final October 18, 2019, for a median follow-up of 2.7 years.
The cohort included 1434 patients from BEST-CLI (mean [SD] age, 67 [10] years; 1026 male [71.5%]).
In the base case analysis, over a 5-year time horizon, the mean per-person direct medical costs were $118 559 (95% credible interval [CrI], $86 978-$157 152) for bypass surgery and $125 535 (95% CrI, $96 205-$160 357) for endovascular surgery.
The mean survival per person was 3.84 years (95% CrI, 3.74-3.93 years) and 3.78 years (95% CrI, 3.61-3.94 years) for bypass and endovascular surgery, respectively.
The mean quality-adjusted life-years per person were 2.53 (95% CrI, 2.34-2.70) for bypass surgery and 2.48 (95% CrI, 2.28-2.67) for endovascular surgery.
This cost-effectiveness study found that bypass surgery was more cost-effective in most probabilistic simulations; however, uncertainty remained, highlighting the need for future research to identify subgroups in whom each approach may be cost-effective.