Direct and Indirect Economic Burden Due to Chronic Limb-Threatening Ischemia (CLTI) in Germany
Author(s)
Foteini Tsotra, MPH, MSc1, Finbar Dolan, PhD, CEng2, Jasper Ubels, PhD3, Jos C. van den Berg, MD, PhD4.
1WifOR Institute, Athens, Greece, 2Versono Medical Ltd., Galway, Ireland, 3WifOR Institute, Darmstadt, Germany, 4Interventional Radiology, Clinica Luganese Moncucco, Lugano, Switzerland.
1WifOR Institute, Athens, Greece, 2Versono Medical Ltd., Galway, Ireland, 3WifOR Institute, Darmstadt, Germany, 4Interventional Radiology, Clinica Luganese Moncucco, Lugano, Switzerland.
OBJECTIVES: Chronic Limb-Threatening Ischemia (CLTI), is the most advanced stage of peripheral artery disease (PAD), affecting approximately 11% of the 230 million PAD patients globally. CLTI significantly increases the risk of amputation and usually revascularization is required to prevent limb loss. This study aimed to evaluate the direct and indirect costs of CLTI in Germany.
METHODS: A Markov model with six-month cycles was developed to simulate the lifetime progression and treatment of patients with CLTI. The model incorporated both outpatient (e.g., conservative management, endovascular revascularization) and inpatient interventions (such as amputation, surgical and endovascular revascularization, and conservative care) and their associated costs. The model accounted for complications including re-admissions, re-amputations, and re-interventions. Stabilized patients were assumed to receive ongoing care, including rehabilitation and condition management, to reflect the chronic nature of CLTI. Additionally, the model captured indirect costs (i.e., productivity losses from both paid and unpaid work). Finally, we calculated separately ulceration costs.
RESULTS: The total economic burden of CLTI was estimated at €8.99 billion over lifetime. This included direct healthcare costs of €5.12 billion and productivity losses of approximately €3.87 billion. The cost of key interventions included €1.22 billion for amputations (mean cost: €35,608), €1.92 billion for endovascular revascularizations (mean cost: €20,283), and €910.82 million for surgical revascularizations (mean cost: €23,872). The remaining direct cost was primarily associated with conservative care. Costs increased with age and were higher among males. Unhealed ulcerations cost was estimated at €1.64 billion.
CONCLUSIONS: CLTI lead to a considerable economic burden, driven by high healthcare costs and substantial productivity losses.
METHODS: A Markov model with six-month cycles was developed to simulate the lifetime progression and treatment of patients with CLTI. The model incorporated both outpatient (e.g., conservative management, endovascular revascularization) and inpatient interventions (such as amputation, surgical and endovascular revascularization, and conservative care) and their associated costs. The model accounted for complications including re-admissions, re-amputations, and re-interventions. Stabilized patients were assumed to receive ongoing care, including rehabilitation and condition management, to reflect the chronic nature of CLTI. Additionally, the model captured indirect costs (i.e., productivity losses from both paid and unpaid work). Finally, we calculated separately ulceration costs.
RESULTS: The total economic burden of CLTI was estimated at €8.99 billion over lifetime. This included direct healthcare costs of €5.12 billion and productivity losses of approximately €3.87 billion. The cost of key interventions included €1.22 billion for amputations (mean cost: €35,608), €1.92 billion for endovascular revascularizations (mean cost: €20,283), and €910.82 million for surgical revascularizations (mean cost: €23,872). The remaining direct cost was primarily associated with conservative care. Costs increased with age and were higher among males. Unhealed ulcerations cost was estimated at €1.64 billion.
CONCLUSIONS: CLTI lead to a considerable economic burden, driven by high healthcare costs and substantial productivity losses.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE331
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas