Procedural and 12 month in-hospital costs of primary infra-popliteal bypass surgery, infra-popliteal best endovascular treatment, and major lower limb amputation for Chronic Limb Threatening Ischaemia

ABSTRACT Background Chronic limb threatening ischaemia (CLTI) is a growing global problem due to the widespread use of tobacco and increasing prevalence of diabetes. Although the financial consequences are considerable, few studies have compared the relative cost-effectiveness of different CLTI management strategies. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-2 trial is randomising CLTI patients to primary infra-popliteal (IP) vein bypass surgery (BS) or best endovascular treatment (BET) and includes a comprehensive within-trial cost-utility analysis. Aim To compare over a 12-month time horizon, the costs of primary IP BS, IP best endovascular treatment (BET), and major limb major amputation (MLLA) to inform the BASIL-2 cost-utility analysis. Methods We compared procedural human resource (HR) costs and total in-hospital costs for the index admission, and over the following 12-months, in 60 consecutive patients undergoing primary IP BS (n=20), IP BET (n=20), or MLLA (10 transfemoral and 10 transtibial ) for CLTI within the BASIL prospective cohort study. Results Procedural HR costs were greatest for BS (BS £2,551, 95% CI: £1,934–2,807 vs. MLLA £1,130 95% CI: £1,046–1,297 vs. BET £329, 95% CI: £242-390, p Conclusion Over a 12-month time horizon, MLLA and IP BS are more expensive than IP BET in terms of procedural HR costs and total in-hospital costs. These economic data together with quality of life data from BASIL-2 will inform the calculation of incremental cost-effectiveness ratios for different CLTI management strategies within the BASIL-2 cost-utility analysis.