The costs of managing lower limb-threatening ischaemia

One hundred and fifty consecutive patients presenting with limb-threatening ischaemic were studied prospectively to determine treatment and rehabilitation costs in the first year. Limb salvage was attempted in 104 (69%) patients but failed in 13%. Mortality at 1 year was 27%. The cost of treatment, inpatient stay occupational therapy physiotherapy, convalescence, disablement services, home adaptations, home care, district nursing, transportation and outpatient visits were determined for each patient. The patients were classified according to their presentation and initial treatment into five groups (number of patients) whose median management costs (interquartile range) for 12 months were: Gp 1 (23) - Revascularisation for acute ischaemia = pound 3970 (2984 - 5511) Gp 2 (29) - Angioplasty for critical ischaemia = pound 6611 (3630 - 10200) Gp 3 (52) - Reconstruction for critical ischaemia = pound 6766 (4337 - 9677) Gp 4 (34) - Primary amputation = pound 10162 (7894 - 13026) Gp 5 (12) - Primary bilateral amputations = pound 13848 (11440 - 18056) At 1 year, there was no significant difference in the cost of managing a patient with a critically ischaemic limb by angioplasty or surgical reconstruction. The cost of revascularisation for acute ischaemia was comparatively low because these patients required minimal rehabilitation. The median cost of managing a patient following amputation was almost twice that of successful limb salvage justifying nit aggressive revascularisation policy. However, justification of such a policy on economic grounds requires salvage failure episodes to be minimised as they increase costs considerably