Cost-Efficacy Issues in the Treatment of Peripheral Vascular Disease: Primary Amputation or Revascularization for Limb-threatening Ischemia

Research output: Contribution to journalArticle

Abstract

Controlling rising health care costs represents a major challenge to our society. Due to the aging of the population and the increasing number of patients with vascular disease, vascular specialists will be under mounting pressure by the managed care industry to provide the most cost-effective care for these patients. One particular controversy is whether to attempt revascularization in the patient with limb-threatening ischemia or to proceed directly with primary amputation. Although it has been assumed that the operative risk for revascularization procedures is high in elderly patients with a severely ischemic limb, mortality rates in the sickest patients are actually higher for amputation. It is also incorrect to assume that the duration of hospitalization is shorter for patients undergoing amputation than for patients undergoing revascularization. For both types of procedures, it is complications that prolong the length of hospital stay, and the rate of secondary amputation following a revascularization attempt is low (8.5%), compared with the rate of operative revision in patients following primary below-knee amputation (23%). The costs for revascularization and primary amputation are similar when the costs of a prosthesis and rehabilitative therapy are included in the calculations for amputation. The rationale for primary amputation assumes that patients will ambulate successfully with a prosthesis; however, many do not, and thus costs for institutionalization must be included in the equation. Long-term costs following revascularization were $28,374 in patients with a viable limb, compared with $56,809 in those undergoing secondary revascularization. The key to minimizing health care costs in this population is careful patient selection for initial revascularization, with aggressive long-term surveillance to ensure graft patency and limb viability.

Original languageEnglish (US)
JournalJournal of Vascular and Interventional Radiology
Volume6
Issue number6 PART 2
DOIs
StatePublished - 1995
Externally publishedYes

Fingerprint

Peripheral Vascular Diseases
Amputation
Ischemia
Extremities
Costs and Cost Analysis
Therapeutics
Health Care Costs
Prostheses and Implants
Length of Stay
Institutionalization
Managed Care Programs
Vascular Diseases
Patient Selection
Population
Blood Vessels
Knee
Patient Care
Industry
Hospitalization
Transplants

Keywords

  • Arteries, surgery
  • Arteries, transluminal angioplasty
  • Arteriosclerosis
  • Cost-effectiveness
  • Extremities, amputation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

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title = "Cost-Efficacy Issues in the Treatment of Peripheral Vascular Disease: Primary Amputation or Revascularization for Limb-threatening Ischemia",
abstract = "Controlling rising health care costs represents a major challenge to our society. Due to the aging of the population and the increasing number of patients with vascular disease, vascular specialists will be under mounting pressure by the managed care industry to provide the most cost-effective care for these patients. One particular controversy is whether to attempt revascularization in the patient with limb-threatening ischemia or to proceed directly with primary amputation. Although it has been assumed that the operative risk for revascularization procedures is high in elderly patients with a severely ischemic limb, mortality rates in the sickest patients are actually higher for amputation. It is also incorrect to assume that the duration of hospitalization is shorter for patients undergoing amputation than for patients undergoing revascularization. For both types of procedures, it is complications that prolong the length of hospital stay, and the rate of secondary amputation following a revascularization attempt is low (8.5{\%}), compared with the rate of operative revision in patients following primary below-knee amputation (23{\%}). The costs for revascularization and primary amputation are similar when the costs of a prosthesis and rehabilitative therapy are included in the calculations for amputation. The rationale for primary amputation assumes that patients will ambulate successfully with a prosthesis; however, many do not, and thus costs for institutionalization must be included in the equation. Long-term costs following revascularization were $28,374 in patients with a viable limb, compared with $56,809 in those undergoing secondary revascularization. The key to minimizing health care costs in this population is careful patient selection for initial revascularization, with aggressive long-term surveillance to ensure graft patency and limb viability.",
keywords = "Arteries, surgery, Arteries, transluminal angioplasty, Arteriosclerosis, Cost-effectiveness, Extremities, amputation",
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