OBJECTIVES: Peripheral arterial disease (PAD) is an atherosclerotic process that reduces blood flow to the limbs. In occluded or stenosed arteries a lower limb bypass procedure can be performed with surgical approach with autologous veins or endovascular approach with covered stent grafts. This study compares the impact on hospital resources of these two treatment strategies for lower limb bypass.

METHODS: A 50 patient scenario was modelled for each strategy, endoluminal bypass using GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface* (EB-CS) and surgical bypass using vein or prosthetic vascular grafts (SB-VG). Resource consumption use and rates were sourced from the SUPERB randomised controlled trial (NCT01220245), including hospital stay for bypass procedure, wound infections and reinterventions over 12 months, use of different types of bed locations (ward, medium or intensive care), operating room time, general/local anaesthesia, number of prosthetic vascular grafts and covered stent-grafts. The hospital provider perspective was adopted. Change in resource consumption was compared between the two strategies.

RESULTS: Overall the EB-CS treatment strategy used less hospital resources over 12 months. Based on a 50 patient scenario, the EB-CS strategy used 118 less ward bed days (261 vs. 379), 18 less medium care bed days (5 vs. 23), 3 less intensive care bed days (0 vs. 3) and 50 hours less operating room time (100 hours vs. 150 hours). It had fewer patients who needed general anaesthesia (31 vs. 39), fewer wound infections (3 vs.12 infections) and subsequent hospitalisations (1 vs. 5). Reinterventions rates were similar between the strategies.

CONCLUSIONS: Using an endovascular strategy for lower limb bypass reduces critical hospital resource use, e.g., operating room time, medium/intensive care and bed days that can be utilized elsewhere to treat patients. In the current climate of high pressure on hospital services the opportunity cost of these resources should be considered.