Significant Savings with a Stepped Care Model for Treatment of Patients with Intermittent Claudication

Objectives International guidelines recommend supervised exercise therapy (SET) as primary treatment for intermittent claudication (IC). The aim of this study was to calculate treatment costs in patients with IC and to estimate nationwide annual savings if a stepped care model (SCM, primary SET trea...

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Published in:European journal of vascular and endovascular surgery 2014-10, Vol.48 (4), p.423-429
Main Authors: Fokkenrood, H.J.P, Scheltinga, M.R.M, Koelemay, M.J.W, Breek, J.C, Hasaart, F, Vahl, A.C, Teijink, J.A.W
Format: Article
Language:English
Subjects:
Aged
Cost Savings
Cost-analysis
Cost-Benefit Analysis
Exercise Therapy - economics
Female
Follow-Up Studies
Guidelines as Topic
Hospital Costs
Humans
Intermittent Claudication - economics
Intermittent Claudication - therapy
Male
Models, Organizational
Netherlands
Peripheral arterial disease
Retrospective Studies
Surgery
Treatment strategies
Vascular Surgical Procedures - economics
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Summary:Objectives International guidelines recommend supervised exercise therapy (SET) as primary treatment for intermittent claudication (IC). The aim of this study was to calculate treatment costs in patients with IC and to estimate nationwide annual savings if a stepped care model (SCM, primary SET treatment followed by revascularization in case of SET failure) was followed. Methods Invoice data of all patients with IC in 2009 were obtained from a Dutch health insurance company (3.4 million members). Patients were divided into three groups based on initial treatment after diagnosis (t0 ). The SET group received SET initiated at any time between 12 months before and up to 3 months after t0 . The intervention group (INT) underwent endovascular or open revascularization between t0 and t+3 months . The third group (REST) received neither SET nor any intervention. All peripheral arterial disease related invoices were recorded during 2 years and average costs per patient were calculated. Savings following use of a SCM were calculated for three scenarios. Results Data on 4954 patients were analyzed. Initial treatment was SET ( n  = 701, 14.1%), INT ( n  = 1363, 27.5%), or REST ( n  = 2890, 58.3%). Within 2 years from t0 , invasive revascularization in the SET group was performed in 45 patients (6.4%). Additional interventions (primary at other location and/or re-interventions) were performed in 480 INT patients (35.2%). Some 431 REST patients received additional SET ( n  = 299, 10.3%) or an intervention ( n  = 132, 4.5%). Mean total IC related costs per patient were €2,191, €9851 and €824 for SET, INT, and REST, respectively. Based on a hypothetical worst, moderate, and best case scenario, some 3.8, 20.6, or 33.0 million euros would have been saved per annum if SCM was implemented in the Dutch healthcare system. Conclusion Implementation of a SCM treatment for patients with IC may lead to significant savings of health care resources.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2014.04.020