Abstract
A cost analysis of the utilization of new expensive vascular grafts is performed, applying the methodology of decision analysis to the theoretical case of a sixty year old male patient undergoing femoropopliteal grafting for limb threatening ischemia. The problem is presented graphically as a decision tree, uncertainties are quantified in terms of probabilities and end outcomes are evaluated in monetary terms. This informations is then utilized to calculate cost values associated with alternative actions.
Based on initial cumulative patency figures of the new more expensive grafts and the known performance of the older grafts, the initial high expense for the new grafts is justified economically, if the saphenous vein is not available. This analysis, apart from giving an answer to a specific clinical problem, can be viewed as a general model for cost analysis of surgical procedures.
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Baird, R. N., and Abbott, W. A.: ‘Vein grafts: An historical perspective’,Amer. J. Surg. 134 (1977) 293–296.
Barnes, B. A., and Barnes, A. B.: ‘Evaluation of therapy by cost benefit analysis’,Surgery 82 (1977) 21–33.
Buda, J. A., Weber, C. J., McAllister, F. F., and Vorrhees, A. B.: “Factors influencing patency of femoropopliteal artery bypass grafts’,Amer. J. Surg. 132 (1976) 8–12.
Bunker, J. P., Barnes, B. A., and Mosteller, F. (eds):Costs, Risks, and Benefits of Surgery, Oxford University Press, New York, 1977.
Campbell, C. D., Goldfarb, D., and Roe, R.: ‘A small arterial substitute expanded microporous polytetraflouroethylene: Patency versus porosity’,Ann. Surg. 182 (1975) 138–143.
Campbell, C. D., Brooks, D. H., Webster, N. W., and Bahnson, H. T.: ‘The use of expanded microporous polytetraflouroethylene for limb salvage: A preliminary report’,Surgery 79 (1976) 485–491.
Card, I., and Mooney, G. H.: ‘What is the monetary value of a human life’,Brit. med. J. 1977/II, 1627–1629.
Connaughton, D.: ‘The drive toward cost containment’,Bull. Amer. Coll. Surg. 63 (1978) 2–3.
Cutler, B. S., Thompson, J. E., Kleinsasser, L. J., and Hempel, G. K.: ‘Autologous saphenous vein femoropopliteal bypass grafting: Analysis of 298 cases’,Surgery 79 (1976) 325–331.
Dale, W. A.: ‘New modification of bovine heterograft for femoropopliteal reconstruction’,J. cardiovasc. Surg. 11, (1970) 83–86.
Dale, W. A., and Lewin, M. R.: ‘Further experience with bovine arterial grafts’,Surgery 80, (1976) 711–721.
Dardik, H., and Dardik, I. I.: ‘Successful arterial substitution with modified human umbilical vein’,Ann. Surg. 183, (1976) 258.
Dardik, H., Ibrahim, I. M., Sprayregen, S., and Dardik, I. I.: ‘Clinical experience with modified human umbilical cord vein for arterial bypass’,Surgery 79, (1976) 618–624.
Dardik, H., Ibrahim, I. M., Baier, R., Sprayregen, S., Levy, M., and Dardik, I. I.: ‘Human umbilical cord: A new source for vascular prosthesis’,J. Amer. med. Ass. 236 (1976) 2859–2862.
Darling, R. C., and Linton, R. R.: ‘Durability of femoropopliteal reconstructions. Endarterectomy versus vein bypass grafts’,Amer. J. Surg. 123, (1972) 472–479.
DeWeese, J. A., and Rob, C. G.: ‘Autogeneous venous bypass grafts five years later’,Ann. Surg. 174, (1971) 346–356.
Harmon, J. W., and Hoar, C. S.: ‘Cloth Femoeral-popliteal bypass grafts in 29 diabetic patients’,Arch. Surg. 106, (1973) 283–285.
Keshishian, J. M., Smyth, N. P. D., Adkins, P. C., Camp, F., and Yahr, W. Z.: ‘Surgical techniques using the bovine arterial graft’,Surg. Gynec. Obstet. 133, (1971) 268–272.
Logerfo, F. W., Carson, J. D., and Mannick, J. A.: ‘Improved results with femoropopliteal vein grafts for limb salvage’,Arch. Surg. 112, (1977) 567–570.
Lye, C. R., Sumner, D. S., and Strandness, S. E.: ‘The effects of femoropopliteal vein graft failure on limb function’,Ann. Surg. 183, (1976) 38–41.
Martin, C. E., and Foster, J. H.: ‘Factual palliation with femoropopliteal bypass for salvage’,S. Surg. Res. 18, (1975) 215–220.
Myhre, H. O.: ‘Bypass grafting for femoropopliteal atherosclerosis’,Acta chirung. Scand. 143, (1977) 109–113.
Pauker, S. G.: ‘Coronary artery surgery: The use of decision analysis’,Ann. intern. Med. 85, (1976) 8–18.
Pauker, S. G., and Kassirer, J. P.: ‘Therapeutic decision making: A cost-benefit analysis’,N. Engl. J. Med. 293, (1975) 229–234.
Pliskin, N., and Taylor, A. K.: ‘General principles: Cot-benefit and decision analysis’. In [4] pp. 5–27.
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Based on a paper delivered at the Symposium on Graft Materials In Vascular Surgery, New Jersey, June 1978.
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Adar, R., Pliskin, N. Cost analysis of the utilization of new vascular grafts. Metamedicine 1, 213–223 (1980). https://doi.org/10.1007/BF00883116
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DOI: https://doi.org/10.1007/BF00883116