LAUSR

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<.001, Kruskal-Wallis) due to longer procedure duration and greater staff requirement. With regard to the index admission, MLLA was the most expensive due to longer hospital stay (MLLA £13,320, 95% CI: £8,986-18,616 vs. BS £8,714, 95% CI: £6,097-11,973 vs. BET £4,813, 95% CI: £3,529-6,097, p<.001, Kruskal-Wallis). The total cost of the index admission and in-hospital care over the following 12-months remained least for BET (MLLA £26,327, 95% CI: £17,653-30,458 vs. BS £20,401, 95% CI: £12,071-23,926 vs. BET £12,298, 95% CI: £6,961-15,439, p<.001, Kruskal-Wallis). 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.