ORIGINAL ARTICLES   

International Angiology 2004 June;23(2):108-13

Copyright © 2004 EDIZIONI MINERVA MEDICA

lingua: Inglese

Economic evaluation of a short-course intensive rehabilitation program in patients with intermittent claudication

Ambrosetti M. ¹, Salerno M. ¹, Boni S. ², Daniele G. ³, Tramarin R. ⁴, Pedretti R. F. E. ⁴

¹ Division of Cardiology, Section of Angiology, IRCCS Salvatore Maugeri Foundation, Institute of Tradate (Varese), Italy 2 Health Care Department, IRCCS Salvatore Maugeri Foundation, Institute of Tradate (Varese), Italy 3 Administrative Department, IRCCS Salvatore Maugeri Foundation, Institute of Tradate (Varese), Italy 4 Division of Cardiology, IRCCS Salvatore Maugeri Foundation, Institute of Pavia, Pavia, Italy

Aim. The aim of this study was to pro­vide cost-descrip­tion and cost-effec­tive­ness of a short-­course inten­sive in-hos­pi­tal reha­bil­i­ta­tion pro­gram in ­patients with inter­mit­tent claud­i­ca­tion.
Meth­ods. Costs per case treat­ed were cal­cu­lat­ed accord­ing to a local stan­dard pro­to­col includ­ing diag­nos­tic eval­u­a­tion of periph­er­al arte­ri­al dis­ease and other relat­ed car­di­o­vas­cu­lar con­di­tions, phys­i­cal train­ing, and sec­on­dary pre­ven­tion. Three addi­tion­al less struc­tured sce­nar­ios were also eval­u­at­ed.
­Results. All 107 ­enrolled ­patients (males 91%, mean age 65±8 years) com­plet­ed the pro­gram (4-week dura­tion; twice a day walk­ing exer­cise) and ­showed sig­nif­i­cant increas­es in walk­ing per­for­mance, as eval­u­at­ed by con­stant tread­mill-test. At admis­sion, the mean val­ues of ­initial claud­i­ca­tion dis­tance (ICD) and abso­lute claud­i­ca­tion dis­tance (ACD) were 150±111 and 432±327 m, respec­tive­ly. At the end of the pro­gram, 12 (11%) ­patients com­plet­ed the tread­mill test with­out pain, while 31 (29%) com­plet­ed the test with­out stop­ping due to max­i­mal pain. Among the remain­ing 64 (60%) ­patients, the ICD and ACD ­increased by 137% and 112%, respec­tive­ly. The cost per case treat­ed ­ranged from € 1 733.2 (stan­dard pro­to­col) to € 9 18.9 (phys­i­cal train­ing only). By add­ing the cost of hos­pi­tal­iza­tion and indi­rect costs, the same costs ­ranged from € 4 626.2 to € 3 811.9. The aver­age cost to walk one addi­tion­al meter with­out pain as a ­result of the reha­bil­i­ta­tion pro­gram was € 57.5, while the cost to walk one addi­tion­al meter ­before stop­ping was € 27. As ­showed by sen­si­tiv­ity anal­y­sis, the main­te­nance of the expect­ed level of treat­ment suc­cess was cru­cial for ­program’s cost-effec­tive­ness.
Con­clu­sion. From the soci­etal view­point, short-­course inten­sive reha­bil­i­ta­tion may be cost-effec­tive in ­patients with ­stable inter­mit­tent claud­i­ca­tion and could be con­sid­ered in deci­sion mod­els eval­u­at­ing dif­fer­ent ther­a­peu­tic ­options.