A vein bypass first versus a best endovascular treatment first revascularization strategy for patients with chronic limb-threatening ischaemia who require an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularization procedure to restore limb perfusion: the BASIL-2 within-trial health economic analysis
Abdali, Zainab Kigozi, Jesse Moakes, Catherine A Bate, Gareth R Hall, Jack Kelly, Lisa Meecham, Lewis Bradbury, Aandrew W Popplewell, Matthew A
Abdali, Zainab
Kigozi, Jesse
Moakes, Catherine A
Bate, Gareth R
Hall, Jack
Kelly, Lisa
Meecham, Lewis
Bradbury, Aandrew W
Popplewell, Matthew A
Affiliation
University of Birmingham; University Hospital Birmingham, University Hospital Wales, The Dudley Group NHS Foundation Trust
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Publication date
2025/06/28
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Abstract
Background: Chronic limb-threatening ischaemia (CLTI) places a considerable socioeconomic burden health and social care systems worldwide. The objective of this health economic analysis was to investigate the cost-effectiveness (CEA) and cost-utility (CUA) of a vein bypass (VB) first versus a best endovascular treatment (BET) first revascularization strategy in patients with CLTI who require an infra-popliteal revascularization procedure to restore limb perfusion.
Methods: CEA and CUA analyses were conducted from the perspective of the UK National Health Service. Patient-level resource use and health outcomes data collected from the BASIL-2 trial over 2-7 years of follow-up were utilized to estimate incremental cost-effectiveness ratios expressed as cost per amputation-free life year (AFLY) and cost per quality-adjusted life year (QALY). EQ-5D-5L was used to generate participant QALYs at 2 and 3 years.
Results: At two years, the mean(s.d.) discounted hospital cost was £15 742.59(16 182.60) and £13 273.66(15 446.92) in the VB-first and BET-first revascularization strategy groups respectively. The lower costs (-£2524.23, 95% c.i., -£5844.93 to £1131.52) in the BET-first group were mainly due to the reduced number of days in hospital and lower procedural costs. BET-first was also more effective leading to additional AFLYs (0.429, 95% c.i., 0.03 to 0.88) at 7 years and discounted QALYs (0.016, 95% c.i., -0.08 to 0.12) at 2 years.
Conclusion: A best endovascular first revascularization strategy dominated a vein bypass first strategy in the cost-effectiveness and cost-utility analyses. The findings were robust across different scenarios and prespecified subgroups.
Citation
Abdali Z, Kigozi J, Moakes CA, Bate GR, Hall J, Kelly L, Meecham L, Bradbury AW, Popplewell MA; BASIL-2 Investigators. A vein bypass first versus a best endovascular treatment first revascularization strategy for patients with chronic limb-threatening ischaemia who require an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularization procedure to restore limb perfusion: the BASIL-2 within-trial health economic analysis. Br J Surg. 2025 May 31;112(6):znaf119. doi: 10.1093/bjs/znaf119.