THE CHOICE OF STRATEGY IN THE TREATMENT OF INTERMITTENT CLAUDICATION - A DECISION TREE APPROACH

Objectives: to compare possible outcomes of the non-operative treatment for intermittent claudication with that of surgery. Design: decision tree approach using published and vascular registry data. The valuation of clinical outcomes was estimated by index weights using the Rosser index and the Quality of Well-Being scale. Setting: routine health care in Sweden. Materials: published data on 224 non-operatively treated claudicants and data from 805 claudicants treated with surgery or angioplasty from the Swedvasc registry. No diabetics were included. Chief outcome measure: expected utility value at one year after decision on treatment given the clinical data and the estimated health status valuations. Main results: it was possible to identify a success rate for surgery above which it was the better alternative. However, depending on which of two health indices that was used, and if reconstruction was supra- or infrainguinal, this threshold value varied from 0-81 %. Conclusions: reliable measures of the value of outcomes have to be developed and, in addition, long-term data on outcome and costs in routine care have to be collected before a comprehensive economic assessment based on the decision tree approach can be made to support decisions on treatment for intermittent claudication. © 1993 Grune & Stratton Ltd.