Justification of intervention for limb-threatening ischemia: a surgical decision analysis

Intervention for vascular occlusive disease of the distal lower extremity i n elderly patients will inevitably be scrutinized as medical resources decl ine, The authors applied surgical decision analysis to three treatment opti ons: revascularization, amputation and expectant management. The appropriat e outcome probabilities were derived from our experience with revasculariza tion to the tibial and pedal vessels, and utility scores were obtained by f ormalized patient assessment. Revascularization was predicted to improve pa tient outcome by 1.10 quality-adjusted life-years compared with primary amp utation and by 1.16 quality-adjusted life-years compared with expectant man agement, To gain one additional quality-adjusted life-years, revascularizat ion would cost $5280 more than expectant management, but $33,900 less than primary amputation. Sensitivity analysis predicted revascularization to be the least costly treatment per quality-adjusted life-years as long as 1-mon th patency exceeds 11%. Revascularization for limb-threatening ischemia of the distal lower extremity is justified and can be performed at a reasonabl e cost. (C) 1998 The International Society for Cardiovascular Surgery. Publ ished by Elsevier Science Ltd. All rights reserved.