Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication

2016 ◽  
Vol 103 (12) ◽  
pp. 1616-1625 ◽  
Author(s):  
M. M. L. van den Houten ◽  
G. J. Lauret ◽  
F. Fakhry ◽  
H. J. P. Fokkenrood ◽  
A. D. I. van Asselt ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Supervised Exercise ◽  
Endovascular Revascularization

scholarly journals Endovascular Revascularization Plus Supervised Exercise Versus Supervised Exercise Only for Intermittent Claudication: A Cost-Effectiveness Analysis

2021 ◽  
Author(s):  
Farzin Fakhry ◽  
Ellen V. Rouwet ◽  
Reinier Spillenaar Bilgen ◽  
Lijckle van der Laan ◽  
Jan J. Wever ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Intermittent Claudication ◽  
Societal Perspective ◽  
Supervised Exercise ◽  
Endovascular Revascularization ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: The ERASE (Endovascular Revascularization and Supervised Exercise) study showed that a combination therapy of endovascular revascularization followed by supervised exercise resulted in greater improvement in walking ability and quality of life as compared with supervised exercise only (standard care) in patients with intermittent claudication. The cost-effectiveness of the combination therapy as compared with supervised exercise is not well defined. In this report, the cost-effectiveness analysis of the ERASE study is presented. Methods: Two hundred twelve patients were randomly assigned to the combination therapy (n=106) or supervised exercise only (n=106) and were followed for 12 months. Cumulative costs per patient were collected using the in-hospital resource utilization data and cost-questionnaires. Quality-adjusted life years were estimated using the EuroQol-5D questionnaire. Incremental cost-effectiveness ratios were calculated from both the health care and societal perspective. The associated uncertainty was determined using bootstrap techniques and acceptability curves. Results: As compared with supervised exercise only, the combination therapy cost an additional €1.462 (99% CI, 388 to 3862) from the health care perspective and €161 (99% CI, −2286 to 3106) from the societal perspective. Accumulated quality-adjusted life- years during 1 year follow-up were 0.042 (99% CI, −0.009 to 0.118) higher in the combination therapy group. The incremental cost-effectiveness ratio was €34.810 from the health care perspective and €3.833 from the societal perspective. Compared with supervised exercise, at a willingness-to-pay threshold of €80.000 per quality-adjusted life-year, the combination therapy had a probability of 87% and 95% of being cost-effective from the health care and societal perspective, respectively. Conclusions: Combination therapy of endovascular revascularization followed by supervised exercise is clinically and economically a more attractive approach than supervised exercise only for intermittent claudication up to 12-month follow-up. Yet, the long-term cost- and clinical effectiveness of both strategies for specific patient groups remains to be defined. REGISTRATION: URL: https://www.trialregister.nl ; Unique identifier: NTR2249.

Supervised exercise therapy for intermittent claudication: current status and future perspectives

Vascular ◽  
2012 ◽  
Vol 20 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Gert-Jan Lauret ◽  
Daniëlle C W van Dalen ◽  
Edith M Willigendael ◽  
Erik J M Hendriks ◽  
Rob A de Bie ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Randomized Clinical Trials ◽  
Walking Distance ◽  
Current Status ◽  
Current Evidence ◽  
Vascular Intervention ◽  
Supervised Exercise ◽  
Co Morbidity ◽  
Health Related

Intermittent claudication (IC) has a high prevalence in the older population and is closely associated with cardiovascular and cerebrovascular disease. High mortality rates are reported due to ongoing atherosclerotic disease. Because of these serious health risks, treatment of IC should address reduction of cardiovascular events (and related morbidity/mortality) and improvement of the poor health-related quality of life (QoL) and functional capacity. In several randomized clinical trials and systematic reviews, supervised exercise therapy (SET) is compared with non-supervised exercise, usual care, placebo, walking advice or vascular interventions. The current evidence supports SET as the primary treatment for IC. SET improves maximum walking distance and health-related QoL with a marginal risk of co-morbidity or mortality. This is also illustrated in contemporary international guidelines. Community-based SET appears to be at least as efficacious as programs provided in a clinical setting. In the Netherlands, a national integrated care network (ClaudicatioNet) providing specialized care for patients with IC is currently being implemented. Besides providing a standardized form of SET, the specialized physical therapists stimulate medication compliance and perform lifestyle coaching. Future research should focus on the influence of co-morbidities on prognosis and effect of SET outcome and the potential beneficial effects of SET combined with a vascular intervention.

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