Economic impact of limb-salvage strategies in chronic limb-threatening ischaemia: modelling and budget impact study based on national registry data.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae099
Athanasios Saratzis, Hany Zayed, Anna Buylova, William Rawlinson, Giota Veliu, Markus Siebert
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Abstract

Background: Missed opportunities to reduce numbers of primary major lower-limb amputation and increase limb-salvage procedures when treating chronic limb-threatening ischaemia have previously been identified in the literature. However, the potential economic savings for healthcare providers when salvaging a chronic limb-threatening ischaemia-affected limb have not been well documented.

Methods: A model using National Health Service healthcare usage and cost data for 1.6 million individuals and averaged numbers of primary surgical procedures for chronic limb-threatening ischaemia from England and Wales in 2019-2021 was created to perform a budget impact analysis. Two scenarios were tested: the averaged national rates of major lower-limb amputation (above the ankle joint), angioplasty, open bypass surgery or arterial endarterectomy in the National Vascular Registry (current scenario); and revascularization rates adjusted based on the lowest amputation rate reported by the National Vascular Registry at the time of the study (hypothetical scenario). The primary outcome was the net impact on costs to the National Health Service over 12 months after the index procedure.

Results: In the current scenario, the proportions of different index procedures were 10% for lower-limb major amputation, 55% for angioplasty, 25% for open bypass surgery and 10% for arterial endarterectomy. In the hypothetical scenario, the procedure rates were 3% for major lower-limb amputation, 59% for angioplasty, 27% for open bypass surgery and 11% for arterial endarterectomy. For 16 025 index chronic limb-threatening ischaemia procedures, the total care cost in the current scenario was €243 924 927. In the hypothetical scenario, costs would be reduced for index procedures (-€10 013 814), community care (-€633 943) and major cardiovascular events (-€383 407), and increased for primary care (€59 827), outpatient appointments (€120 050) and subsequent chronic limb-threatening ischaemia-related surgery (€1 179 107). The net saving to the National Health Service would be €9 645 259.

Conclusion: A shift away from primary major lower-limb amputation towards revascularization could lead to substantial savings for the National Health Service without major cost increases later in the care pathway, indicating that care decisions taken in hospitals have wider benefits.

肢体挽救策略对慢性肢体缺血威胁的经济影响:基于国家登记数据的建模和预算影响研究。
背景:以前曾有文献指出,在治疗慢性肢体缺血时,减少主要下肢截肢和增加肢体抢救程序的机会已经错过。然而,在抢救受慢性肢体缺血威胁的肢体时,医疗服务提供者可能节省的经济成本却没有得到很好的记录:方法:利用英格兰和威尔士 160 万人的国民健康服务医疗保健使用和成本数据以及 2019-2021 年慢性肢体危重缺血初级外科手术的平均数量创建了一个模型,以进行预算影响分析。测试了两种方案:国家血管登记处的全国主要下肢截肢(踝关节以上)、血管成形术、开放式搭桥手术或动脉内膜切除术的平均比率(当前方案);根据国家血管登记处在研究时报告的最低截肢率调整的血管再通率(假设方案)。主要结果是指数手术后12个月内对国民健康服务成本的净影响:结果:在当前情况下,不同指数手术的比例分别为:下肢大截肢术 10%、血管成形术 55%、开放式搭桥手术 25%、动脉内膜切除术 10%。在假设情况下,下肢大截肢率为 3%,血管成形术为 59%,开放式搭桥手术为 27%,动脉内膜切除术为 11%。对于 16 025 例慢性危及肢体缺血指数手术,当前情景下的总护理成本为 243 924 927 欧元。在假设方案中,指数手术(-10 013 814 欧元)、社区护理(-633 943 欧元)和重大心血管事件(-383 407 欧元)的费用将减少,而初级护理(59 827 欧元)、门诊预约(120 050 欧元)和随后的慢性肢体缺血相关手术(1 179 107 欧元)的费用将增加。国民医疗服务的净节省额为 9 645 259 欧元:结论:从主要的下肢截肢手术转向血管再通手术,可为国家卫生服务部门节省大量费用,而不会导致后期护理成本大幅增加,这表明医院做出的护理决定具有更广泛的益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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