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. 2022 Sep 19;19(18):11792.
doi: 10.3390/ijerph191811792.

Discrete Event Simulation Model for Cost-Effectiveness Evaluation of Screening for Asymptomatic Patients with Lower Extremity Arterial Disease

Vojtěch Kamenský  1 , Vladimír Rogalewicz  1 , Ondřej Gajdoš  1 , Gleb Donin  1
Affiliations

Discrete Event Simulation Model for Cost-Effectiveness Evaluation of Screening for Asymptomatic Patients with Lower Extremity Arterial Disease

Vojtěch Kamenský et al. Int J Environ Res Public Health. .

Abstract

Lower limb ischemic disease (LEAD) affects a significant portion of the population, with most patients being asymptomatic. Patient screening is necessary because LEAD patients have an increased risk of occurrence of other cardiovascular events and manifestations of disease, in terms of leg symptoms such as intermittent claudication, critical limb ischemia, or amputation. The aim of this work was to evaluate the cost-effectiveness of screening using ABI diagnostics in asymptomatic patients and its impact on limb symptoms associated with LEAD. A discrete event simulation model was created to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as QALYs. A cost-effectiveness analysis was performed to compare ABI screening examination and the situation without such screening. A probabilistic sensitivity analysis and scenario analysis were carried out to evaluate the robustness of the results. In the basic setting, the screening intervention was a more expensive intervention, at a cost of CZK 174,010, compared to CZK 70,177 for the strategy without screening. The benefits of screening were estimated at 14.73 QALYs, with 14.46 QALYs without screening. The final ICER value of CZK 389,738 per QALY is below the willingness to pay threshold. Likewise, the results of the probabilistic sensitivity analysis and of the scenario analysis were below the threshold of willingness to pay, thus confirming the robustness of the results. In conclusion, ABI screening appears to be a cost-effective strategy for asymptomatic patients aged 50 years when compared to the no-screening option.

Keywords: ankle-brachial index; cost-effectiveness analysis; discrete event simulation; lower extremity arterial disease; screening.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Considered states in the model and possible transitions between states.
Figure 2
Figure 2
(A): Mean cumulative costs (CZK) per patient; (B): Mean cumulative QALYs per patient.
Figure 3
Figure 3
(A): Cost-effectiveness scatter plane with input variability; (B): cost-effectiveness acceptability curve for probabilistic analysis with input variability.
See this image and copyright information in PMC

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