The cost-effectiveness of exclusion arteriography in extremity trauma

The purpose of this study was to apply decision analysis to an established practice in vascular trauma diagnosis. While exclusion arteriography has re sulted in an increase in positive surgical explorations, no formal analysis that determined either the cost-effectiveness of exclusion arteriography o r the cost-effectiveness ratio has been reported in the literature. We crea ted a decision model that compared exclusion arteriography and surgical exp loration, the standard used prior to the development of extremity arteriogr aphy. The decision model used predominantly literature derived estimates fo r the prevalence of arterial injuries and the accuracy, complications, outc omes and costs of both arteriography and exploration. Exclusion arteriograp hy is cost-effective. This finding is robust to changes in the major model variables. Compared to surgical exploration, exclusion arteriography is a s uperior strategy by dominance (more effective and costs less). Therefore, a cost-effectiveness ratio cannot be calculated. Under the base case assumpt ion of 28% prevalence of arterial injury requiring operation, exclusion art eriography saves about $2000 and adds 0.3 quality adjusted life years (QALY ) for each patient. Decision analysis can be successfully applied to proble ms in vascular trauma diagnosis. (C) 2001 The International Society for Car diovascular Surgery. Published by Elsevier Science Ltd. All rights reserved .