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Neal R. Barshes, MD, MPH, James D

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1 Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss 
Neal R. Barshes, MD, MPH, James D. Chambers, PhD, MPharm, MSc, Joshua Cohen, PhD, Michael Belkin, MD  Journal of Vascular Surgery  Volume 56, Issue 4, Pages e1 (October 2012) DOI: /j.jvs Copyright © Terms and Conditions

2 Fig 1 Schematic diagram demonstrates an overview of the patient-oriented clinical states modeled in the computer simulation for critical limb ischemia (CLI) management strategies 3 to 6. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © Terms and Conditions

3 Fig 2 The annual costs per living patient are demonstrated during the 10-year interval after the initiation of various management strategies: (A) strategy 1 (local wound care); (B) strategy 2 (primary amputation); (C) strategy 3 (surgical bypass with surgical revision); (D) strategy 4 (surgical bypass with endovascular revision); (E) strategy 5 (purely endovascular intervention); and (F) strategy 6 (endovascular intervention, surgical bypass for failure). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © Terms and Conditions

4 Fig 3 The incremental costs (in 2009 U.S. dollars) and incremental benefits (quality-adjusted life-years) are demonstrated for strategy 4 (surgical bypass with endovascular revision) compared with strategy 1 (local wound care with amputation as indicated). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © Terms and Conditions

5 Fig 4 Cost-effectiveness acceptability curves are shown for critical limb ischemia (CLI) management strategies compared with strategy 1 (local wound care). The probability of strategy 4 (surgical bypass with endovascular revision) being a cost-effective alternative increases as the willingness-to-pay threshold in U.S. dollars (USD) surpasses $39,255 per quality-adjusted life-year. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © Terms and Conditions

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