| 3 |
Informational/Educational Report
|
Comparing excimer laser-angioplasty, bypass surgery, PTA, and primary amputation in CLI and limb salvage: an economic outcome analysis David E. Allie, MD, Chris J. Hebert, RT, RCIS, Craig M. Walker, MD Background: Multiple reports document the higher economic costs of primary amputation (PA) versus infrainguinal bypass surgery (IBS). The literature suggests initial revascularization treatment for critical limb ischemia (CLI) to be IBS = 38%, balloon angioplasty (BA) = 28%, and PA = 16%. The 6-month Laser Angioplasty for Critical Limb Ischemia (LACI) trial 93% limb salvage rate prompted a CLI and laser economic analysis by an independent data analysis resource..Methods: Between 1999Ð2001 a CLI population of 417 patients with an infrainguinal amputation were identified from a 2.5 million Medicare/insurance dataset. Clinical data and all medical claims for 18 months were analyzed for BA, IBS, and PA. Based on LACI trial phase II results, economic outcomes were used and compared to BA, IBS and PA treatment by substituting laser treatment as the initial treatment in lieu of the actual treatment Results: Initial treatments for CLI were PA = 67%, IBS = 23%, PTA = 10%. Only 35% of CLI cases had an ankle brachial index (ABI) and only 16% angiography before PA. Average total costs / patient = $31,638 without laser and $25,373 with laser. Average savings / patient with laser revascularization = $6,265 Conclusion: CLI and limb salvage treatment is still characterized by high rates of PA without vascular evaluations. A laser revascularization first treatment strategy has the potential for significant economic and clinical savings.. |
|