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
.