A new study published in BJS Open has found that revascularisation treatment to restore blood flow to the legs of patients with severely blocked arteries is no more expensive than carrying out an amputation.
The peer-reviewed paper is the first to compare the total costs of follow-up care after revascularisation and major lower limb amputation across primary, secondary and community settings in the UK. Many previous studies have focused only on the immediate costs of the procedures to a hospital.
The observational research, carried out by the Department of Cardiovascular Sciences at the University of Leicester and commissioned by global healthcare company Abbott, analysed routinely collected data for 4,252 patients who were diagnosed with Critical Limb Threatening Ischaemia (CLTI) between January 2016 and January 2019.
296 patients (6.9%) underwent an angioplasty, 75 (1.7%) had bypass surgery, and 141 (3.3%) a major lower limb amputation as their first procedure.
Patients undergoing amputation had the highest number of community care appointments in the 12 months after their operation, and far longer inpatient stays if they needed to be readmitted to hospital during that time. They also had the highest number of cardiovascular events and deaths at one-year.
This meant the combined costs of postoperative care at one year following major lower limb amputation (£7,140.90) were comparable to those of the most common procedures to restore blood flow such as angioplasty (£7,040.00) and bypass surgery (£7,481.90).
CLTI is a severe form of Peripheral Artery Disease (PAD), a common condition which affects a fifth of the population over the age of 55 3,4,5, where a build-up of fatty deposits in the arteries restricts blood supply to the legs. It is the most common cause of limb amputation.
Despoina Apergi, 51, Stevenage, said: “At 44 years old, I was told I needed to have a lower limb amputation due to my health condition, I was shocked and scared at the prospect – the impact it would have had on my life would have been enormous. I was told that there was no alternative, and I was even booked in for the procedure at the hospital. It was by chance that I was introduced to Professor Athanasios Saratzis through personal connections, and he was able to offer me an alternative treatment which saved my limb. I was upset and angry that I came so close to avoidably losing a limb, but I hope that the findings published in this study help many more people, like me, to get access to limb saving treatment.”
Associate Professor at the Department of Cardiovascular Sciences, University of Leicester and lead author of the paper, Athanasios Saratzis, said: “There had been a misconception that revascularisation is more expensive than amputation, but by looking at the true combined costs of follow-up care across the whole health system, we have for the first time been able to reveal the significant postoperative costs of amputation. With better patient outcomes, we’re calling for revascularisation to become the default treatment option for eligible patients.”
Mr Hany Zayed, Consultant Vascular and Endovascular Surgeon, Guy’s and St Thomas’ NHS Foundation Trust, said: “It is important to consider the overall cost of patients with CLTI to the wider healthcare system. In order to achieve this, we needed to examine the cost implications of the patients’ contacts with health services throughout their whole journey. This approach will provide real reflection of the financial burden on the NHS of various management approaches to CLTI. This study highlights the real cost of limb amputation, which contrary to some beliefs, seems to be more expensive overall than most limb salvage approaches. This work provides valuable knowledge to inform those who look after patients with CLTI and those who fund their care.”
Jonathan Wood, Regional Director - North Europe, Abbott Vascular, added: “Our goal is to continue to support physicians with the technology and research they need to deliver improved patient health outcomes. This new study provides a valuable resource for physicians who may be considering appropriate treatment for patients with Critical Limb Threatening Ischaemia.”
The study can be found here: https://doi.org/10.1093/bjsopen/zrad112