Cost-utility Analysis of the Outpatient Versus Conventional Hospitalization in Treatment of Occlusive Arterial Disease
- Conditions
- Peripheral Arterial Disease
- Interventions
- Procedure: Treatment of Occlusive Arterial Disease
- Registration Number
- NCT02581150
- Lead Sponsor
- Nantes University Hospital
- Brief Summary
The purpose of this study is to assess the efficiency of outpatient surgery compared to conventional hospitalization in endovascular treatment of occlusive arterial disease. A cost-utility analysis will be conducted from a societal perspective. Patients referred for peripheral arterial disease (PAD) will be randomized in two arms and a 3 months follow-up will be performed.
- Detailed Description
Rationale for ambulatory hospitalization is based on increased demand of hospital care, hospital budgets constraints and patients who ask for a prompt recovery. Consequently, physicians should find ways to optimize the resources' allocation, without compromising quality, safety and efficiency of patient care. Several studies and routine practice have shown that ambulatory hospitalization was safe but we are still lacking evidence to demonstrate the cost-utility of this kind of management.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 160
- Patients limping
- Patients with PAD requiring endovascular management
- Patients with stabilized level 1 to 3 ASA (classification of the American Society of Anesthesiology)
- Ability to walking
- Endovascular indicated and compatible with an introducer 5F to 7F
- Agreeing to participate in the study and having signed an informed consent.
- Agreeing to lend itself to a post-operative monitoring a duration of 30 days
- Social Insured
- No possibility of an outpatient management
- Previous participation in the AMBUVASC study
- Refusal of patient to participate in the study
- Patient with hemostasis disorders
- Acute Ischemia
- Using a more 7F introducer
- Radial or brachial puncture
- Antegrade femoral puncture
- Contraindication to endovascular treatment
- Less than one month life expectancy
- Participation in another clinical trial
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Outpatient hospitalisation Treatment of Occlusive Arterial Disease The intervention is the Treatment of Occlusive Arterial Disease, during an ambulatory hospitalisation, with the use of an arterial closure device (ACD). The patients treated for PAD (Peripheral Arterial Disease) are informed and prepared in the morning of D0. The surgical endovascular procedure is performed at D0 before 1:00 p.m. The patients leave the hospital in the evening at D0 after a systematic visit. Conventional inpatient hospitalisation Treatment of Occlusive Arterial Disease The intervention is the Treatment of Occlusive Arterial Disease, during a conventional hospitalisation, with or without ACD (ACD will be used at the discretion of the interventionalist). The patients treated for PAD arrive at the hospital the day before surgery (D-1). The surgical endovascular procedure takes place the next day (D0). The day after (D1), the patients leave the hospital after a systematic visit.
- Primary Outcome Measures
Name Time Method Incremental Cost Effectiveness Ratio (ICER) comparing cost and utility in the two arms 3 months The objective of the study is to perform a cost-utility analysis comparing outpatient surgery to conventional hospitalization in endovascular treatment of occlusive arterial disease. The analysis will be conducted from a society's perspective using a one-month time horizon following the date of intervention (and 2 months before intervention). A microcosting approach will be used to estimate the cost of the surgical intervention in both arms and all subsequent in-hospital and ambulatory care resources consumption will be systematically recorded during the one month follow-up period. Effectiveness will be assessed in terms of Quality-Adjusted Life-Years (QALYs) estimated from patients' answers to the Euroqol EQ-5D questionnaire and french preferences scores. Results will be presented as an incremental cost-per-QALY ratio.
- Secondary Outcome Measures
Name Time Method Time period to back-to-work 1 month The time period to back-to-work will be assessed through the measurement of the duration of sick leave for people who work.
Budget impact analysis 5 years The budget impact analysis will estimate the net financial profit (the difference between the costs incurred and profits obtained, or avoided costs) in developing the ambulatory surgery in the management of PAD. The perspective adopted will be that of the health care facilities and of the National health insurance. This analysis will be conducted in a 5 years time horizon to consider a full exploitation of the potential for substitution between conventional hospitalisation and ambulatory hospitalisation for eligible patients.
Functional improvement 1 month The assessment of the functional improvement will be performed with Rutherford Classification.
Complication rates 1 month The major vascular complications that can occur within 30 days are: Complications Intraoperative, Hematoma, Bleeding from the groin, arteriovenous fistula, Pseudo aneurysm, retroperitoneal hemorrhage, Critical Ischemia, Infection, Thrombosis.
Trial Locations
- Locations (11)
Besançon University Hospital
🇫🇷Besançon, France
Colmar Hospital
🇫🇷Colmar, France
Dijon University Hospital
🇫🇷Dijon, France
Clinique de Fontaine
🇫🇷Fontaine les Dijon, France
La Roche sur Yon Hospital
🇫🇷La Roche sur Yon, France
Marseille University Hospital (La Timone)
🇫🇷Marseille, France
Nantes University Hospital
🇫🇷Nantes, France
Rennes University Hospital
🇫🇷Rennes, France
Marseille University Hospital (North)
🇫🇷Marseille, France
Rouen Clinique de l'Europe
🇫🇷Rouen, France
Saint-Etienne University Hospital
🇫🇷Saint-Etienne, France