Hospital and Institutionalisation Care Costs after Limb and Visceral Ischaemia Benchmarked Against Stroke: Long-Term Results of a Population Based Cohort Study

Luengo-Fernández, Ramón; Howard, Dominic P J; Nichol, K G; Dobell, Emily; Rothwell, Peter M.

doi:10.1016/j.ejvs.2018.03.007

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…Comparing patients undergoing arthrodesis or amputation for a failed two‐stage, these studies have limited numbers but identified similar functional outcomes and complication rates along with high satisfaction in the amputation group 16,25 . There is no evidence reviewing economic cost of amputation for PJI versus a two‐stage revision, however two‐stage revision TKA carries significant economic costs and there is likely a cost benefit of AKA 5,7,8,26 …”

Section: Discussionmentioning

confidence: 99%

“…16,25 There is no evidence reviewing economic cost of amputation for PJI versus a two-stage revision, however two-stage revision TKA carries significant economic costs and there is likely a cost benefit of AKA. 5,7,8,26 The authors recommend counselling patients appropriately, discussing all the options and considering less invasive options such as DAIR and suppression or an amputation in patients who have failed a prior two-stage revision TKA. This study did not identify any factors contributing to treatment failure with all repeat twostage revision TKA patients at high risk.…”

Section: Discussionmentioning

confidence: 99%

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Repeat two‐stage revision for knee prosthetic joint infection results in very high failure rates

Christiner

Yates

Prosser

2021

ANZ Journal of Surgery

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Introduction Two stage revision total knee arthroplasty (TKA) is the gold standard for treatment and eradication of knee prosthetic joint infections (PJI), but the literature is limited on the outcomes of repeat two‐stage TKA after PJI recurrence. This study presents the outcomes of repeat two‐stage revision TKA and investigates potential factors contributing to success or failure, aiming to assist counselling and decision‐making. Methods A retrospective study was undertaken investigating all two‐stage revision TKA performed at one institution between 2005 and 2020. Twenty cases underwent repeat two‐stage revision TKA. Patient outcomes and factors contributing to treatment success or failure were investigated. PJI was diagnosed according to MSIS criteria. Results Of the 20 cases, 14 were classified as failed treatment (70%) due to a failure to eradicate infection, further surgical intervention or death. In this cohort, there were no statistically significant differences between the groups regarding factors contributing to treatment success or failure. In the success group, patient reported functional outcomes were variable. Conclusion This study demonstrates that patients undergoing a repeat two‐stage TKA have very poor outcomes. This study did not identify any factors that predicted failure. Patients need to be counselled regarding poor outcomes with repeat two‐stage TKA, and other treatment options such as early amputation or lifelong suppression should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repeat two‐stage revision for knee prosthetic joint infection results in very high failure rates

Christiner

Yates

Prosser

2021

ANZ Journal of Surgery

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“…Costs were based on the average of unit cost in the UK NHS, for 2017/18, and were expressed in pounds Sterling (£GBP). The cost estimates for the Markov states and patient cohort were pooled from the national schedule of NHS reference costs [ 33 ] and other published literature [ 11 , 34 , 35 ]. These costs were inflated in accordance to the Hospital and Community Health Services pay and price index (HCHS) [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease

et al. 2021

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Background Critical limb ischaemia is a severe stage of lower limb peripheral artery disease which can lead to tissue loss, gangrene, amputation and death. FlowOx™ therapy is a novel negative-pressure chamber system intended for home use to increase blood flow, reduce pain and improve wound healing for patients with peripheral artery disease and critical limb ischaemia. Methods A Markov model was constructed to assess the relative cost-effectiveness of FlowOx™ therapy compared to standard care in lower limb peripheral artery disease patients with intermittent claudication or critical limb ischaemia. The model used data from two European trials of FlowOx™ therapy and published evidence on disease progression. From an NHS analysis perspective, various FlowOx™ therapy scenarios were modelled by adjusting the dose of FlowOx™ therapy and the amount of other care received alongside FlowOx™ therapy, in comparison to standard care. Results In the base case analysis, consisting of FlowOx™ therapy plus nominal care, the cost estimates were £12,704 for a single dose of FlowOx™ therapy per annum as compared with £15,523 for standard care. FlowOx™ therapy patients gained 0.27 additional quality adjusted life years compared to standard care patients. This equated to a dominant incremental cost-effectiveness ratio per QALY gained. At the NICE threshold WTP of £20,000 and £30,000 per QALY gained, FlowOx™ therapy in addition to standard care had a 0.80 and 1.00 probability of being cost-effectiveness respectively. Conclusions FlowOx™ therapy delivered as a single annual dose may be a cost-effective treatment for peripheral artery disease. FlowOx™ therapy improved health outcomes and reduced treatment costs in this modelled cohort. The effectiveness and cost-effectiveness of FlowOx™ therapy is susceptible to disease severity, adherence, dose and treatment cost. Research assessing the impact of FlowOx™ therapy on NHS resource use is needed in order to provide a definitive economic evaluation.

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“… 1 , 5 , 6 The estimated five year economic cost of ALI is over €24 000 per patient. 7 Although venous thromboembolism is a known consequence of malignancy, the relationship between cancer and acute arterial thromboembolism is less well established, 8 with evidence of increased incidence derived primarily from smaller case series. 8 , 9 The increased risk of thromboembolic events in patients with cancer is complex and multifactorial; both the underlying disease and systemic treatments lead to a prothrombotic state, exacerbated by tumorigenic inflammatory responses, abnormal protein metabolism, and haemodynamic compromise leading to subsequent stasis.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Acute Limb Ischaemia in Patients with Underlying Malignancy: A Systematic Review

Kelly

Toale

Moloney

et al. 2022

EJVES Vascular Forum

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Objective Previous studies have demonstrated amputation and mortality rates to be 14.3% – 30% and 11.4% – 28.9%, respectively, for all patients presenting with acute limb ischaemia (ALI). Rates of ALI are higher in patients with malignancy than in those without. Despite this, there remains uncertainty with regards to the most appropriate management for patients with cancer presenting with ALI. This is because of previously published high rates of associated morbidity and mortality in this population. The aim of this review was to summarise the available evidence reporting on outcomes of ALI in patients with underlying malignancy. Method A systematic review was performed in August 2020 in accordance with the PRISMA guidelines. The Medline, Scopus, Cochrane, and Embase databases were searched with the following search string ((acute limb ischaemia) OR (acute limb ischemia)) AND ((cancer) OR (malignancy)). A total of 849 papers were identified and reviewed; six studies were included. Studies were assessed for bias using the National Institute of Health/National Heart, Lung and Blood Institute Quality Assessment Tool. Data including demographics, Rutherford classification, baseline performance scores, method of revascularisation, and peri-procedural outcomes were extracted and analysed. Data were pooled based on outcomes of interest and pooled prevalence was reported with 95% confidence intervals (CI). Results Six studies with 284 patients with cancer were included for analysis. The pooled overall risk of amputation was 15% (95% CI 5.9 – 26.9). The pooled 30 day mortality rate was 24% (95% CI 14.7 – 34.6). Conclusion Despite limitations of interstudy selection bias and some clinical heterogeneity, the included studies demonstrated acceptable short and medium term outcomes for patients with cancer undergoing revascularisation for acute limb ischaemia. This is in line with current recommendations that patients with underlying malignancy should be considered strongly for revascularisation.

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Hospital and Institutionalisation Care Costs after Limb and Visceral Ischaemia Benchmarked Against Stroke: Long-Term Results of a Population Based Cohort Study

Cited by 8 publications

References 22 publications

Repeat two‐stage revision for knee prosthetic joint infection results in very high failure rates

Repeat two‐stage revision for knee prosthetic joint infection results in very high failure rates

Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease

Outcomes of Acute Limb Ischaemia in Patients with Underlying Malignancy: A Systematic Review

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