Biomedical subjects

E Buskens

Publications and source records attributed to E Buskens.

At least 37 records · Page 2Linked to original sources

PubMed2004

Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome.

STUDY DESIGN: A systematic review of the literature, pertaining surgical treatment of traumatic thoracic and lumbar spine fractures, was performed. OBJECTIVES: To provide information on surgical techniques for traumatic spine fracture management, their respective performance and complication rates, based on previously published information. SUMMARY OF BACKGROUND DATA: The treatment of traumatic fractures of the thoracic and lumbar spine remains controversial. There is insufficient evidence in the literature to choose between the various surgical options. In absence of conclusive studies, a systematic review can be an alternative to obtain more convincing information. METHODS: Full-text papers from 1970 until 2001 were included if strict inclusion criteria were met. Five surgical subgroups were recognized: posterior short-segment (PS), posterior long-segment (PL), reports on both posterior short- and long-segment (PSL), anterior (A), and anterior combined with posterior (AP) techniques. Clearly defined and generally accepted parameters were scored and subsequently analyzed. The preoperative injury severity of the surgical groups was compared. The neurologic, radiologic, and functional outcome and complications of all groups were assessed. RESULTS: A total of 132 papers, the majority being retrospective case-series, were included representing 5,748 patients. The preoperative injury severity revealed an inequality between the subgroups. Partial neurologic deficits had the potential to resolve irrespective of treatment choice. None of the five techniques used was able to maintain the corrected kyphosis angle. The functional outcome after surgery seems to be better than generally believed. Complications are relatively rare. CONCLUSIONS: In general, surgical treatment of traumatic spine fractures is safe and effective. Surgical techniques can only be compared using randomized controlled trials.

Adult↗

PubMed2004

Yield of screening for new aneurysms after treatment for subarachnoid hemorrhage.

OBJECTIVE: Patients who have been successfully treated for subarachnoid hemorrhage (SAH) are at risk for new episodes. The authors studied the effect of screening with CT angiography (CTA) for new aneurysms. METHODS: In a decision model, the authors compared the strategies "screening" and "no screening" after SAH. A literature review yielded the risks of aneurysm recurrence, complications of CTA, and re-treatment. The authors estimated the expected number of quality-adjusted life-years (QALYs), the number of SAH, and the mortality and disability rates for both strategies. They evaluated screening at intervals of 2, 5, and 10 years after SAH, using 10 years and remaining life expectancy as time horizon. RESULTS: The expected number of QALYs 10 years after clipping was virtually the same for no screening (8.33), screening once after 5 years (8.28), and screening every 2 years (8.27). With screening every 2 years, the expected rate of new SAH decreased from 1.9 to 0.5%, and mortality decreased from 0.9 to 0.6%; however, the disability rate increased from 0.5 to 1.9%. Results were comparable with remaining life expectancy as time horizon and for screening after initial treatment with coils. The key estimates of the analyses were the incidence and rupture rate of new aneurysms, the risk of dying from recurrent SAH, the utility of disability, and the risk of complications from DSA and re-treatment. CONCLUSIONS: Presently, screening for new aneurysms after subarachnoid hemorrhage cannot be recommended. Screening may prevent new episodes of subarachnoid hemorrhage but with too high a cost in terms of complications from preventive treatment.

Adult↗

PubMed2004

Cost-effectiveness of stereotactic large-core needle biopsy for nonpalpable breast lesions compared to open-breast biopsy.

This paper demonstrates that the introduction of large-core needle biopsy (LCNB) replacing needle-localised breast biopsy (NLBB) for nonpalpable (screen-detected) breast lesions could result in substantial cost savings at the expense of a possible slight increase in breast cancer mortality. The cost-effectiveness of LCNB and NLBB was estimated using a microsimulation model. The sensitivity of LCNB (0.97) and resource use and costs of LCNB and NLBB were derived from a multicentre consecutive cohort study among 973 women who consented in getting LCNB and NLBB, if LCNB was negative. Sensitivity analyses were performed. Replacing NLBB with LCNB would result in approximately six more breast cancer deaths per year (in a target population of 2.1 million women), or in 1000 extra life-years lost from breast cancer (effect over 100 years). The total costs of management of breast cancer (3% discounted) are estimated at pound 4676 million with NLBB; introducing LCNB would save pound 13 million. The incremental cost-effectiveness ratio of continued NLBB vs LCNB would be pound 12 482 per additional life-year gained (3% discounted); incremental costs range from pound -21 687 (low threshold for breast biopsy) to pound 74 378 (high sensitivity of LCNB).

Aged↗

PubMed2004

Quality of life endovascular and open AAA repair. Results of a randomised trial.

AIM: To compare the quality of life (QoL) in the first postoperative year after elective endovascular abdominal aortic aneurysm repair (EVAR) and open repair (OR) in a randomised study. METHODS: In the Dutch Randomised Endovascular Aneurysm Management (DREAM) trial, patients are randomly allocated to EVAR or OR. QoL questionnaires (SF-36 and EuroQoL-5D) were sent to all patients preoperatively (PREOP) and at five time points in the first postoperative year (3W, 6W, 3M, 6M and 12M). Between November 1999 and August 2002, 153 patients (141 male; 12 female) were randomised (78 EVAR and 75 OR; one crossover from OR to EVAR). The EuroQoL-5D scores and the eight domains of the SF-36 for the two groups were compared using the Mann-Whitney test. Changes over time were analysed using the Wilcoxon sign test. RESULTS: There were no statistically significant differences in baseline characteristics (age, gender and SVS risk factors). The preoperative QoL scores of the study group were similar to the QoL scores of the general population of the same age. After 3W the OR group showed a significant decrease on the EuroQol-5D (p=0.022) and in six of the eight SF-36 domains. The EVAR group also showed a significant decrease on the EuroQol-5D (p=0.004) and in 5 of the 8 domains of the SF-36. At 6W the EuroQol-5D had recovered to baseline in the OR group and the decreased domains of the SF-36 had partially recovered. In the EVAR group the EuroQol-5D and three of the five decreased SF-36 domains, had returned to baseline. From 6M on, the OR group reported a significantly higher score on the EuroQoL-5D than the EVAR group (p=0.045 (6M) and p=0.001 (12M)). CONCLUSION: In the early postoperative period there is a small, yet significant QoL advantage for EVAR compared to OR. At 6 months and beyond, patients reported better QoL after OR than after EVAR.

Aged↗

PubMed2004

Scaling the sickness impact profile using item response theory: an exploration of linearity, adaptive use, and patient driven item weights.

BACKGROUND AND OBJECTIVE: The objective of the study was to enhance the clinical interpretation and practicality of the widely used comprehensive Sickness Impact Profile. METHOD: Item Response Theory (extension of the Rasch model) was used to calibrate the severity of the SIP items, to assess item bias and to construct equally severe short forms of the SIP that can be used interchangeably. The scores of 1507 subjects were analyzed. RESULTS: Of the 127 SIP items, 82 items fitted the extended Rasch model, i.e., the observed proportions of sickness level groups endorsing the items corresponded to the proportions expected by the model. The item severity hierarchy allowed a more straightforward interpretation of the calibrated SIP-82 scores. Some items showed bias in age, gender, or diagnosis groups. The equivalent short forms agreed sufficiently well with the calibrated SIP-82 item pool to be used interchangeably. We observed a moderate correlation between the original SIP item severity weights and the Rasch item severity calibrations (r=0.53). CONCLUSION: The interpretability and practicality of the SIP was enhanced by the IRT calibration. Using the item calibrations, short forms can be assembled that can be used interchangeably.

Calibration↗

PubMed2004

Determinants of direct costs in Dutch rheumatoid arthritis patients.

OBJECTIVES: To estimate annual direct costs in four distinct disease duration groups (0 to < or =2, 2 to < or =6, 6 to < or =10, and >10 years) of patients with rheumatoid arthritis (RA), to determine predictors of high costs and to describe characteristics of patients with high and with low costs. METHODS: A questionnaire assessing RA related care and resource utilisation rates and costs was completed by 615 RA patients. Predictive variables for incurred costs, as observed during the first year after disease onset, were determined in a subgroup of patients (n = 347). RESULTS: Mean (median) annual direct costs for the four groups with increasing disease duration were respectively: 5235 (2923) Euros, 3930 (1968) Euros, 4664 (1952)Euros, and 8243 (3778) Euros, (p < 0.05). During the first 2 years of the disease total direct costs comprised mainly of consultations with healthcare workers (28%). After 10 years, devices and adaptations were the main contributors (40%) to total costs. Positive rheumatoid factor results at the time of diagnosis and deterioration of functional disability in the first year of disease were predictors of high costs later on in the course of the disease. CONCLUSION: Annual direct costs among patients with a disease duration of less than 2 years tend to be lower among patients with a disease duration of between 2 and 10 years than among patients with a disease duration of more than 10 years. In addition, the proportional distribution of different cost categories to total costs increases with with increasing disease duration.

Adult↗

PubMed2004

Patient-reported outcome in total hip replacement. A comparison of five instruments of health status.

Our aim was to define the minimum set of patient-reported outcome measures which are required to assess health status after total hip replacement (THR). In 114 patients, we compared the pre-operative characteristics and sensitivity to change of the Oxford hip score (OHS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the SF-36, the SF-12 (derived from the SF-36), and the Euroqol questionnaire (EQ-5D). At one year after operation, very large effect sizes were found for the disease-specific measures, the physical domains of the SF-12, SF-36 and the EQ-5Dindex (1.3 to 3.0). Patients in Charnley class A showed more change in the OHS, WOMAC pain and function, the physical domains of the SF-36 and the EQ-5Dvas (p < 0.05) compared with those in the Charnley B and C group. In this group, the effect size for the OHS more than doubled the effect sizes of WOMAC pain and physical function. We found high correlations and correlations of change between the OHS, the WOMAC, the physical domains of the SF-12 and the SF-36 and EQ-5Dindex. The SF-36 and EQ-5D scores at one year after operation approached those of the general population. Furthermore, we found a binomial distribution of the pre-operative EQ-5Dindex score and a pre-operative discrepancy and post-operative agreement between the EQ-5Dvas and EQ-5Dindex. We recommend the use of the OHS and SF-12 in the assessment of THR. The SF-36 may be used in circumstances when smaller changes in health status are investigated, for example in the follow-up of THR. The EQ-5D is useful in situations in which utility values are needed in order to calculate cost-effectiveness or quality-adjusted life years (QALYs), such as in the assessment of new techniques in THR.

Aged↗

PubMed2003

Design of the Dutch prevention of influenza, surveillance and management (PRISMA) study.

Rationale and design of a study on the cost-effectiveness of the Dutch influenza vaccination campaign are described. During two influenza epidemics, about 75,000 primary care patients recommended for influenza vaccination are included. Cases have fatal or non-fatal influenza, pneumonia, otitis media, acute respiratory disease (ARD), heart failure, myocardial infarction, depression or diabetes dysregulation. Per case four controls are sampled, frequency matched on age and high-risk co-morbidity (<18 years, 18-64, >/=65 healthy, >/=65 with co-morbidity). Baseline and outcome data are retrieved from patient records. During the 1999-2000 influenza A epidemic 5891 (7.9%) high-risk children, 24,848 (33.2%) high-risk adults aged 18-64 years, 18,484 (24.7%) elderly with co-morbidity and 25,527 (34.1%) healthy elderly had been included. The mortality rate was 5.2 per 1000 and 2035 non-fatal outcome events were recorded (incidence rate 27.2/1000).

Adolescent↗

PubMed2003

A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients.

BACKGROUND & AIMS: Malnutrition is a risk factor for development of pressure ulcers (PU). Nutritional supplementation may thus reduce the incidence of PU. We investigated the effect of nutritional supplementation on incidence of PU in hip-fracture patients at risk of developing PU. METHODS: Hip-fracture patients (n=103) were included in this double-blind, randomised, placebo-controlled trial. They received 400 ml daily of a supplement enriched with protein, arginine, zinc and antioxidants (n=51) or a non-caloric, water-based placebo supplement (n=52). Presence and stage of PU were assessed daily for 28 days or until discharge (median: 10 days during supplementation). RESULTS: Incidence of PU was not different between supplement (55%) and placebo (59%), but incidence of PU stage II showed a 9% difference (difference: 0.091; 95% CI: 0.07-0.25) between supplement (18%) and placebo (28%). Of patients developing PU 57% developed it by the second day. Time of onset (days) showed a trend (P=0.090) towards later onset of PU with supplement (3.6+/-0.9) than placebo (1.6+/-0.9). CONCLUSIONS: Hip-fracture patients develop PU at an early stage. Nutritional supplementation may not prevent PU at this stage, but contributes possibly to a delayed onset and progression of PU. Nutritional supplementation may be more effective if initiated earlier.

Aged↗

PubMed2003

Interobserver variability between general and expert pathologists during the histopathological assessment of large-core needle and open biopsies of non-palpable breast lesions.

The purpose of this study was to assess whether general pathologists are able to make as accurate and reproducible a diagnosis on large-core needle biopsies as on open breast biopsy specimens. A total of 688 patients underwent a stereotactic large-core (14G) needle biopsy and subsequent surgical excision of 718 non-palpable breast lesions. Forty-two pathologists from 10 departments of pathology (generalists) made a diagnosis on both the needle and open biopsy specimens. Afterwards, three pathologists and two radiologists with extensive experience in breast pathology (experts) diagnosed all of the biopsy specimens. The general pathologists made a similar histological diagnosis as the experts in 632 (88%) of the needle biopsies and 649 (90%) of the open biopsy specimens. Accordingly, the interobserver agreement for the diagnosis of large-core needle biopsies between the general and experts pathologists was excellent (kappa 0.83) and not significantly different from the interobserver agreement for the diagnosis of open breast biopsies (kappa 0.86). However, many inconsistencies were observed in the category of borderline lesions: only 24% of the large-core needle biopsies and 43% of the open biopsies with an expert diagnosis of 'borderline' were diagnosed similarly by the general pathologists. Additionally, the risk of benign/malignant inconsistencies between general pathologists and experts was approximately 1 in 55 for both needle and open biopsies.

Adult↗

PubMed2003

Algorithm to determine cost savings of targeting antimicrobial therapy based on results of rapid diagnostic testing.

A rapid diagnosis of pneumococcal pneumonia may allow the earlier use of narrow-spectrum antimicrobial therapy. It is unknown, however, whether rapid diagnostic testing of patients hospitalized with community-acquired pneumonia (CAP) admitted to hospital lowers costs. Therefore, an algorithm to calculate the costs associated with the diagnosis and treatment of CAP was formulated. Subsequently, the algorithm was applied to clinical data for 122 consecutively admitted patients with CAP whose sputum samples were Gram stained and whose urine was tested for Streptococcus pneumoniae antigen. The costs of initial antimicrobial therapy, personnel, and materials were measured. Compared to the most expensive empirical regimen, rapid diagnostic testing would result in cost savings per patient (PP) of 3.51 Euros for Gram staining and 8.11 Euros for urinary pneumococcal antigen testing (1 Euro is equal to 1.13 US dollars, from 2000 to 2002). Compared to the cheapest regimen, Gram staining would increase the cost by 2.25 Euros PP, and urinary antigen testing would increase the cost by 24.26 Euros PP. In our setting, the use of rapid diagnostic testing would not lower costs. Cost savings depend, however, on the differences in the prices of the different antibiotics chosen and the proportion of evaluable and positive samples.

Adult↗

PubMed2003

Decision analysis in the surgical treatment of colorectal cancer due to a mismatch repair gene defect.

BACKGROUND: In view of the high risk of developing a new primary colorectal carcinoma (CRC), subtotal colectomy rather than segmental resection or hemicolectomy is the preferred treatment in hereditary non-polyposis colorectal cancer (HNPCC) patients. Subtotal colectomy however implies a substantial decrease in quality of life. To date, colonoscopic surveillance has been shown to reduce CRC occurrence. AIMS: To compare the potential health effects in terms of life expectancy (LE) for patients undergoing subtotal colectomy or hemicolectomy for CRC. METHODS: A decision analysis (Markov) model was created. Information on the 10 year risk of CRC after subtotal colectomy (4%) and hemicolectomy (16%) and stages of CRCs detected within a two year surveillance interval (32% Dukes' A, 54% Dukes' B, and 14% Dukes' C) were derived from two cohort studies. Five year survival rates used for the different Dukes stages (A, B, and C) were 98%, 80%, and 60%, respectively. Remaining LE values were calculated for hypothetical cohorts with an age at CRC diagnosis of 27, 47, and 67 years, respectively. Remaining LE values were also calculated for patients with CRC of Dukes' stage A. RESULTS: The overall LE gain of subtotal colectomy compared with hemicolectomy at ages 27, 47, and 67 was 2.3, 1, and 0.3 years, respectively. Specifically for Dukes' stage A, this would be 3.4, 1.5, and 0.4 years. CONCLUSIONS: Unless surveillance results improve, subtotal colectomy still seems the preferred treatment for CRC in HNPCC in view of the difference in LE. For older patients, hemicolectomy may be an option as there is no appreciable difference in LE.

Adult↗

PubMed2002

Diagnosing non-palpable breast disease: short-term impact on quality of life of large-core needle biopsy versus open breast biopsy.

BACKGROUND: One of the alleged advantages of stereotactic large-core needle biopsy of non-palpable breast lesions is that it entails less inconvenience for the patient. In this prospective study, the quality of life of patients undergoing large-core needle biopsy was compared with that of patients undergoing open breast biopsy prior to learning the definitive diagnosis. METHODS: Thirty patients with non-palpable breast lesions underwent stereotactic large-core needle biopsy as initial diagnostic procedure (needle biopsy group). Quality of life as perceived by these patients was compared with that of 27 patients who underwent open breast biopsy as initial diagnostic procedure (control group). Both groups completed quality of life questionnaires (EuroQol and SF-36) 1 day before and 4 days after the diagnostic intervention. RESULTS: One day before the diagnostic procedure, the overall estimate for quality of life (measured with the EuroQol) was slightly higher in the needle biopsy group than in the control group (73 versus 69 resp.). Four days after the diagnostic procedure, the quality of life score remained approximately unchanged in the needle biopsy group, but was reduced in the control group (71 versus 61 resp.). Results of the SF-36 questionnaire demonstrated that patients in the needle biopsy group had higher quality of life scores on physical functioning, physical performance, pain and social performance after the diagnostic intervention. CONCLUSION: Stereotactic large-core needle biopsy seems to affect quality of life to a lesser extent than open breast biopsy. This difference is mainly attributable to a reduction of physical discomfort and pain.

Biopsy, Needle↗

PubMed2002

The Dutch Randomised Endovascular Aneurysm Management (DREAM) trial. Background, design and methods.

After the introduction of endovascular repair of abdominal aortic aneurysms (AAA), both benefits and drawbacks of this new technique have been reported. To assess whether the new technique is an adequate substitute of conventional AAA repair, a randomised study is due. The Dutch Randomised Endovascular Aneurysm Management (DREAM) trial is a randomised multicenter trial enrolling patients eligible for elective treatment of infrarenal AAAs. In this study, the cost-effectiveness of endovascular aneurysm repair (EAR) is compared with that of conventional transabdominal surgery, in patients that are considered suitable for both types of treatment. The primary endpoint is combined operative mortality and morbidity. Secondary endpoints and additional assessments include event free survival, quality of life, length of hospital stay and costs. It is expected that the DREAM-trial will lead to a safe and controlled introduction of a new technology. Also, the medical community will obtain valid scientific evidence of the merits of endovascular AAA repair. Finally, policy makers will be provided with accurate cost-effectiveness data for the Dutch healthcare system. The aim of the present paper is to describe the background, methods and design of the DREAM-trial.

Aortic Aneurysm, Abdominal↗

PubMed2001

Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study.

BACKGROUND: The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. METHODS AND RESULTS: In a multicenter trial, 281 patients (mean age 61 years, SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospital results and cardiac outcome and quality of life after 1 month are presented. Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention. The mean numbers of distal anastomoses per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pump groups, respectively. Completeness of revascularization was similar in both groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (P<0.01). Release of creatine kinase muscle-brain isoenzyme was 41% less in the off-pump group (P<0.01). Otherwise, no differences in complications were found postoperatively. Off-pump patients were discharged 1 day earlier. At 1 month, operative mortality was zero in both groups, and quality of life had improved similarly. In both groups, 4% of the patients had recurrent angina. The proportions of patients surviving free of cardiovascular events were 93.0% in the off-pump group and 94.2% in the on-pump group (P=0.66). CONCLUSIONS: In selected patients, off-pump CABG is safe and yields a short-term cardiac outcome comparable to that of on-pump CABG.

Cardiopulmonary Bypass↗

PubMed2001

Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients.

CONTEXT: Although meta-analyses of randomized trials have shown that selective digestive decontamination (SDD) prevents nosocomial pneumonia in critically ill patients, the influence of trial quality on the effectiveness of SDD has not been rigorously evaluated. OBJECTIVE: To assess the methodological quality of individual studies of SDD and its relation to the reported effects on pneumonia and mortality. DESIGN: Thirty-two studies were identified in a MEDLINE and reference list search and their methodological quality was assessed using a scoring system (range, 0-13 points) based on allocation and concealment, patient selection, patient characteristics, blinding of the intervention, and the definition of pneumonia. MAIN OUTCOME MEASURE: Methodological quality of the primary trials and its effect on the relative risk reductions (RRRs) of SDD on pneumonia and mortality. RESULTS: The mean (SD) methodological quality score was 7.8 (2.9) (range, 1-11). The RRRs ranged from -0.1 to 1.0 for pneumonia and from -0.1 to 0.6 for mortality. The methodological quality score was associated with the RRR for pneumonia so that for each quality-point added, the RRR decreased by 5.8% (95% confidence interval, 2.4%-9.3%). No association between trial quality and the impact of SDD was found on mortality. Of the individual trial quality characteristics, patient selection, allocation of intervention, and blinding most strongly influenced the treatment effect. CONCLUSIONS: The inverse relationship between methodological quality score and the benefit of SDD on the incidence of pneumonia may have resulted in overly optimistic estimates of SDD in prior meta-analyses. This emphasizes the importance of rigorous trial design in evaluating preventive interventions in the intensive care unit.

Antibiotic Prophylaxis↗

PubMed2001

Cost comparison between stereotactic large-core-needle biopsy versus surgical excision biopsy in The Netherlands.

Yearly, approximately 7200 Dutch women with non-palpable breast lesions are referred for a diagnostic surgical excision biopsy. Recently, less invasive alternatives such as stereotactic large-core-needle biopsy have emerged. The aim of this study was to compare the costs of surgical excision biopsy and large-core-needle biopsy. As stereotactic equipment is expensive, the costs of large-core-needle biopsy depend on the extent of centralisation of this facility. Therefore, we assessed the extent of economies of scale in four different scenarios of (de)centralisation. We collected cost data in five Dutch hospitals. The cost of surgical excision biopsy amounted to 1184 Euros. In cases where large-core-needle biopsy would be employed decentralised in all 114 hospitals in The Netherlands, the average costs were estimated to be 1186 Euros compared with 572 Euros in a centralised scenario with involvement of 10 hospitals. Therefore, centralisation of stereotactic equipment for core-needle biopsies would be advisable from an economic perspective.

Biopsy↗

PubMed2001

Cost-effectiveness of oral anticoagulants versus aspirin in patients after infrainguinal bypass grafting surgery.

PURPOSE: Several antithrombotic therapies are available for the treatment of patients with peripheral vascular diseases. It is unknown how quality of life and costs of treatment are influenced by different therapies. This study assessed the cost-effectiveness of oral anticoagulants versus aspirin in patients after infrainguinal bypass grafting surgery. METHODS: Clinical outcome events and event-free survival were collected from 2650 patients in 77 centers who participated in the Dutch Bypass Oral anticoagulants or Aspirin trial. Approximately half the patients had critical ischemia; 60% received vein grafts, and 20% had femorocrural bypass grafts. A model that was primarily driven by clinical outcome events was used as a means of determining quality of life (EuroQol EQ-5D) and costs for each patient. The main outcome measure was the incremental health care costs in relation to the additional number of quality-adjusted life years and the additional number of event-free years. RESULTS: The mean costs during the 21 months of follow-up were epsilon 6875 per patient in the oral anticoagulants group versus epsilon 7072 in the aspirin group (difference, 197; 95% CI, -746 to 343). The event-free survival was 1.10 years in the group treated with oral anticoagulants versus 1.09 years in the group treated with aspirin (difference, 0.01; 95% CI, -0.07 to 0.08), whereas the corresponding quality-adjusted life years were 1.06 and 1.05, respectively (difference, 0.01; 95% CI, -0.03 to 0.06). CONCLUSION: Health care costs, event-free survival, and quality-adjusted life years in patients after infrainguinal bypass surgery were not different in patients treated with aspirin and patients treated with oral anticoagulants. The extra costs of monitoring patients treated with oral anticoagulants were limited and play no role in the decision for treatment.

Aged↗