Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-24T17:51:24.345Z Has data issue: false hasContentIssue false
  • English
  • Français

A Cost-Utility Analysis of Laser-Assisted Angioplasty for Peripheral Arterial Occlusions

Published online by Cambridge University Press:  10 March 2009

Mark Sculpher ,
Jonathan Michaels ,
Mike Mckenna  and
Julia Minor
Mark Sculpher
Affiliation:
Brunei University
Jonathan Michaels
Affiliation:
Northern General Hospital NHS Trust
Mike Mckenna
Affiliation:
Battelle (MEDTAP)
Julia Minor
Affiliation:
John Radcliffe Hospital
Get access Rights & Permissions [Opens in a new window]

Abstract

Despite the perception of many people that lasers represent the cutting edge of high-technology medicine, this form of medical technology has been subject to relatively little rigorous evaluation. This dearth of research relates particularly to economic evaluation, where there have been few attempts to justify the high cost of laser equipment. This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions. Using data from a range of sources, including a published randomized trial, a cost-utility model is developed to estimate the costs and benefits of the laser, relative to standard angioplasty. The best available data indicate a cost-effective role for the laser, but important areas of uncertainty exist, including the laser's secondary recanalization rate, which has been estimated on the basis of limited numbers of patients. This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 12 , Issue 1 , Winter 1996 , pp. 104 - 125
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Ahn, S. S., Eton, D., & Moore, W. S.Endovascular surgery for peripheral arterial occlusive disease. Annals of Surgery, 1992, 216, 3–16.CrossRefGoogle ScholarPubMed
2.Anderson, J. B., Wolinski, A. P., Wells, I. P. et al. The impact of percutaneous transluminal angioplasty on the management of peripheral vascular disease. British Journal of Surgery, 1986, 73, 17–19.CrossRefGoogle ScholarPubMed
3.Ashley, S., & Keeler, R. C.Laser angioplasty. British Journal of Surgery, 1993, 80, 550–51.CrossRefGoogle ScholarPubMed
4.Banta, H. D., & Schou, I. (eds.). Lasers in health care, effectiveness, cost-effectiveness and policy implications. Denmark: Academic, 1991.Google Scholar
5.Banta, H. D., & Vondeling, H.Strategies for successful evaluation and policy-making toward health care technology on the move: The case of medical lasers. Social Science and Medicine, 1994, 38, 1663–74.CrossRefGoogle ScholarPubMed
6.Beck, J. R., & Pauker, S. G.The Markov process in medical prognosis. Medical Decision Making, 1983, 3, 419–58.CrossRefGoogle ScholarPubMed
7.Brazier, J. E., Harper, R., Jones, N. M. B. et al. Validating the SF-36 health survey questionnaire: New outcome measure for primary care. British Medical Journal, 1992, 305, 160–64.CrossRefGoogle ScholarPubMed
8.Briggs, A., Sculpher, M., & Buxton, M.Uncertainty in the economic evaluation of health care technologies: The role of sensitivity analysis. Health Economics, 1994, 3, 95–104.CrossRefGoogle ScholarPubMed
9.Cairns, J.Discounting and health benefits: Another perspective. Health Economics, 1992 1, 76–81.CrossRefGoogle ScholarPubMed
10.Cumberland, D. C., Sanborn, T., Tayler, D. I. et al. Percutaneous laser thermal angioplasty: Initial clinical results with a laser probe in total peripheral artery occlusions. Lancet, 1986, 1457–59.CrossRefGoogle Scholar
11.Dormandy, J., Mahir, M., Ascady, G. et al. Fate of patients with chronic leg ischaemia. Journal of Cardiovascular Surgery, 1989, 30, 50–57.Google ScholarPubMed
12.Drabaek, H., Mehlsen, J., Himmelstup, H. et al. A botanical compound, Padma 28, increases walking distance in stable intermittent claudication. Angiology, 1993, 44, 863–67.CrossRefGoogle ScholarPubMed
13.Drummond, M. F., Brandt, A., Luce, B. et al. Standardizing methodologies for economic evaluation in health care. International Journal of Technology Assessment in Health Care, 1993, 9, 26–36.CrossRefGoogle ScholarPubMed
14.Drummond, M. F., Stoddart, G. L., & Torrance, G. W.Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987.Google Scholar
15.EuroQol Group. EuroQol: A new facility for the measurement of health-related quality of life. Health Policy, 1990, 16, 199–208.CrossRefGoogle Scholar
16.Gerard, K.Cost-utility in practice: A policy maker’s guide to the state of the art. Health Policy, 1992, 21, 249–79.CrossRefGoogle ScholarPubMed
17.Hansen, D. D., Auth, D. C., Hall, M. et al. Rotational endarterectomy in normal canine coronary arteries: A preliminary report. Journal of Cardiology, 1988, 11, 1073–77.Google ScholarPubMed
18.H. M. Treasury. Economic appraisal in central government: A technical guide for government departments. London: HMSO, 1991.Google Scholar
19.Hunink, M. G. M., Wong, J. B., Donaldson, M. C. et al. Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease. Medical Decision Making, 1994, 14, 77–81.CrossRefGoogle ScholarPubMed
20.Imparato, A. M., Geun-Eun, K., & Davidson, T.Intermittent claudication: Its natural course. Surgery, 1975, 78, 795–99.Google ScholarPubMed
21.Jeans, W. D., Armstrong, S., Cole, S. E. A. et al. Fate of patients undergoing transluminal angioplasty for lower-limb ischaemia. Interventional Radiology, 1990, 177, 559–64.Google Scholar
22.Jelnes, R., Gaardsting, O., Jensen, K. H. et al. Fate in intermittent claudication: Outcome and risk factors. British Medical Journal, 1986, 293, 1137–40.CrossRefGoogle ScholarPubMed
23.Johnson, B. F., Evans, L., Drury, R. et al. Limb-threatening ischaemia: a reappraisal of the costs and benefits. European Journal of Vascular Disease, in press.Google Scholar
24.Johnston, K. W., Rae, M., Hogg-Johnston, S. A. et al. Five-year results of a prospective study of percutaneous transluminal angioplasty. Annals of Surgery, 1987, 206, 403–13.CrossRefGoogle Scholar
25.Kannel, W. B., Skinner, J. J., Schwartz, M. J. et al. Intermittent claudication. Circulation, 1970, 41, 875–83.CrossRefGoogle ScholarPubMed
26.Kensey, K. R., Zarins, C., Whitimore, A. et al. Dynamic angioplasty as a treatment modality in peripheral vascular disease: The first clinical results. Journal of the American College of Cardiology, 1987, 9, 180.Google Scholar
27.Lammer, J., Pilger, E., Decrinis, M. et al. Pulsed excimer laser versus continuous-wave Nd:YAG laser versus conventional angioplasty of peripheral arterial occlusions: Prospective randomized controlled trial. Lancet, 1992, 340, 1183–88.CrossRefGoogle Scholar
28.Laupacis, A., Feeny, D., Detsky, A. S. et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Canadian Medical Association Journal, 1992, 146, 473–81.Google ScholarPubMed
29.Maynard, A.Developing the health care market. Economic Journal, 1991, 101, 1277–86.CrossRefGoogle Scholar
30.McDaniel, M. D., & Cronenwett, J. L.Basic data related to the natural history of intermittent claudication. Annals of Vascular Surgery, 1989, 3, 273–77.CrossRefGoogle Scholar
31.Mehlsen, J., Himmelstup, H., Himmelstup, B. et al. Beneficial effects of intermittent suction and pressure treatment in intermittent claudication. Angiology, 1993, 44, 16–20.CrossRefGoogle ScholarPubMed
32.Michaels, J. A.Percutaneous arterial recanalization. British Journal of Surgery, 1990, 77, 373–79.CrossRefGoogle ScholarPubMed
33.Michaels, J. A., Browse, D. J., McWhinnie, D. L. et al. The provision of vascular surgical services in the Oxford region. British Journal of Surgery, 1994, 81, 377–81.CrossRefGoogle ScholarPubMed
34.Miller, D. K., & Homan, S. M.Determining transition probabilities: Confusion and suggestions. Medical Decision Making, 1994, 14, 52–58.CrossRefGoogle ScholarPubMed
35.Mohide, E. A., Torrance, G. W., Streiner, D. L. et al. Measuring the well-being of family caregivers using the time trade-off technique. Journal of Clinical Epidemiology, 1988, 41, 475–82.CrossRefGoogle ScholarPubMed
36.Murray, A., Wood, R. F. M., Mitchell, D. C. et al. Peripheral laser angioplasty with pulsed dye laser and ball-tipped optical fibres. Lancet, 1989, 1471–74.CrossRefGoogle Scholar
37.Neilson, S., Robinson, I., & Hunter, M.Static and dynamic models of interdisease competition: Past and projected mortality from amyotrophic lateral sclerosis and multiple sclerosis. Mechanisms of Ageing and Development, 1993, 66, 223–41.CrossRefGoogle ScholarPubMed
38.Nord, E.The validity of a visual analogue scale in determining social utility weights for health states. International Journal of Health Planning and Management, 1991, 6, 234–42.Google ScholarPubMed
39.Norgren, L. Definition, incidence, and epidemiology. In Dormandy, J. A. and Stock, G. (eds.), Critical leg ischaemia: Its pathophysiology and management. Berlin: Springer-Verlag, 1990.Google Scholar
40.Parsonage, M., & Neuberger, H.Discounting and health benefits. Health Economics, 1992, 1, 71–79.CrossRefGoogle ScholarPubMed
41.Rienks, R., & Borst, C. Treatment of atherosclerotic cardiovascular disease: Effectiveness. In Banta, D. and Schou, I., (eds.), Laser in health care: Effectiveness, cost-effectivenes and policy implications. Denmark: Academic, 1991.Google Scholar
42.Riggs, J. E., & Michecchia, R. J.Mortality among the elderly in the U.S. 1956–87: Demonstration of the upper boundary to Gompertzian mortality. Mechanisms of Ageing and Development, 1992, 62, 191–99.CrossRefGoogle Scholar
43.Sanborn, T. A., Cumberland, D. C., Greenfield, A. J. et al. Percutaneous laser thermal angioplasty: Initial results and 1-year follow-up in 129 femoropopliteal lesions. Radiology, 1988, 168, 121–25.CrossRefGoogle ScholarPubMed
44.Schieber, G. J., & Poullier, J. P. Overview of international comparisons of health care expenditures. Health Care Financing Review, 1989, annual supplement, 1–7.Google Scholar
45.Sculpher, M. J.Final Report of the Phase II Medical Laser Technology Assessment, Uxbridge: Brunei University, HERG Research Report No. 18, 1994.Google Scholar
46.Sculpher, M. J., & Buxton, M. J.Report of Phase I of the Medical Laser Technology Assessment. Uxbridge: Brunei University, HERG Research Report No. 9, 1991.Google Scholar
47.Simpson, J. B., Selmon, M. R., Robertson, G. C. et al. Transluminal atherectomy for occlusive peripheral vascular disease. American Journal of Cardiology, 61, 96G–101G.CrossRefGoogle Scholar
48.Sonnenberg, F. A., & Beck, J. R.Markov models in medical decision making. Medical Decision Making, 1993, 13, 322–38.CrossRefGoogle ScholarPubMed
49.Stewart, C. P., Jain, A. S., & Ogston, S. A.Lower limb amputee survival. Prosthetics and Orthotics Information, 1992, 16, 11–18.CrossRefGoogle ScholarPubMed
50.Torrance, G. W.Measurement of health state utilities for economic appraisal: A review. Journal of Health Economics, 1986, 5, 1–30.CrossRefGoogle Scholar
51.Tunis, S. R., Bass, E. B., & Steinberg, E.The use of angioplasty, bypass surgery and amputation in the management of peripheral vascular disease. New England Journal of Medicine, 1991, 325, 556–62.CrossRefGoogle ScholarPubMed
52.Veith, F. J., Gupta, S. K., Wengerter, K. R. et al. Changing arteriosclerotic disease patterns and management strategies in lower-limb-threatening ischemia. Annals of Surgery, 1990, 212, 402–14.CrossRefGoogle ScholarPubMed
53.Ware, J. E., & Donald Sherbourne, C.The MOS 36-item short form health survey (SF36), 1. Conceptual framework and item selection. Medical Care, 1992, 30, 473–83.CrossRefGoogle ScholarPubMed
54.Weinstein, M. C., Fineberg, H. V., & Jones, A.Clinical decision analysis, Philadelphia:W. B. Saunders Company, 1980.Google Scholar
55.Weinstein, M. C., & Stason, W. B. Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 1977.CrossRefGoogle Scholar
56.Williams, A.Economics of coronary artery bypass grafting. British Medical Journal, 1985, 291, 326–29.CrossRefGoogle ScholarPubMed