Improved Adherence to a Stepped-care Model Reduces Costs of Intermittent Claudication Treatment in The Netherlands

D. Hageman; H. J. P. Fokkenrood; P. P. M. Essers; M. J. W. Koelemay; J. C. Breek; A. C. Vahl; M. R. M. Scheltinga; J. A. W. Teijink

doi:10.1016/j.ejvs.2017.04.011

Improved Adherence to a Stepped-care Model Reduces Costs of Intermittent Claudication Treatment in The Netherlands

D. Hageman, H. J. P. Fokkenrood, P. P. M. Essers, M. J. W. Koelemay, J. C. Breek, A. C. Vahl, M. R. M. Scheltinga, J. A. W. Teijink^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective/Background: A previous budget impact analysis regarding a supervised exercise therapy (SET) first treatment strategy (stepped care model [SCM]) for Dutch patients with intermittent claudication (IC) showed a low referral rate in 2009, despite solid evidence of the effectiveness of SET programs. Recently, several campaigns have stimulated stakeholders in the field to adopt a SET first strategy in patients with IC. The aim of the present study was to reassess SCM adherence after a 2 year period.

Methods: IC related invoices of patients in 2011 were obtained from a large Dutch health insurance company (3.5 million persons). Patients were divided into two groups based on their initial treatment. A SET group had started SET between 12 months before (initiated by general practitioner) and 3 months after (initiated by vascular surgeon) presentation at a vascular surgery outpatient clinic. An intervention (INT) group was treated by revascularisation within 3 months of outpatient presentation. Costs of IC treatment in this 2011 cohort were compared with the earlier 2009 cohort.

Results: IC related invoices of 4135 patients were available. In 2011, the initial treatment was SET in 56% (2009: 34%; +22% [p <.001]) and INT in 44% (2009: 66%; -22% [p <.001]) of the IC population. Additional revascularisation was performed in 19% of patients in the SET group (2009: 6%; +13% [p <.001]) and also in 19% of patients in the INT group (2009: 35%; -16% [p <.001]). Later on, 29% of patients in the INT group were referred for SET (2009: 10%; +19% [p <.001]). Average costs of IC treatment per patient in 2011 were 6% lower than in 2009 ((sic)6885 vs. (sic)7300; p = .020).

Conclusion: A 22% increase in adherence to SET as a first treatment strategy in Dutch patients with IC was attained between 2009 and 2011. This shift suggests successful SCM implementation resulting in lower costs for the national healthcare system. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Original language	English
Pages (from-to)	51-57
Number of pages	7
Journal	European Journal of Vascular and Endovascular Surgery
Volume	54
Issue number	1
DOIs	https://doi.org/10.1016/j.ejvs.2017.04.011
Publication status	Published - Jul 2017

Keywords

Budget
Conservative treatment
Economic evaluation
Exercise
Exercise therapy
Intermittent claudication
Peripheral arterial disease
Walking
PERIPHERAL ARTERIAL-DISEASE
SUPERVISED EXERCISE THERAPY
RANDOMIZED CLINICAL-TRIAL
ENDOVASCULAR REVASCULARIZATION
PRACTICE GUIDELINES
OCCLUSIVE DISEASE
LOWER-EXTREMITY
HEALTH SYSTEMS
TASK-FORCE
MANAGEMENT

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Cite this

Hageman, D., Fokkenrood, H. J. P., Essers, P. P. M., Koelemay, M. J. W., Breek, J. C., Vahl, A. C., Scheltinga, M. R. M., & Teijink, J. A. W. (2017). Improved Adherence to a Stepped-care Model Reduces Costs of Intermittent Claudication Treatment in The Netherlands. European Journal of Vascular and Endovascular Surgery, 54(1), 51-57. https://doi.org/10.1016/j.ejvs.2017.04.011

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title = "Improved Adherence to a Stepped-care Model Reduces Costs of Intermittent Claudication Treatment in The Netherlands",

abstract = "Objective/Background: A previous budget impact analysis regarding a supervised exercise therapy (SET) first treatment strategy (stepped care model [SCM]) for Dutch patients with intermittent claudication (IC) showed a low referral rate in 2009, despite solid evidence of the effectiveness of SET programs. Recently, several campaigns have stimulated stakeholders in the field to adopt a SET first strategy in patients with IC. The aim of the present study was to reassess SCM adherence after a 2 year period.Methods: IC related invoices of patients in 2011 were obtained from a large Dutch health insurance company (3.5 million persons). Patients were divided into two groups based on their initial treatment. A SET group had started SET between 12 months before (initiated by general practitioner) and 3 months after (initiated by vascular surgeon) presentation at a vascular surgery outpatient clinic. An intervention (INT) group was treated by revascularisation within 3 months of outpatient presentation. Costs of IC treatment in this 2011 cohort were compared with the earlier 2009 cohort.Results: IC related invoices of 4135 patients were available. In 2011, the initial treatment was SET in 56% (2009: 34%; +22% [p <.001]) and INT in 44% (2009: 66%; -22% [p <.001]) of the IC population. Additional revascularisation was performed in 19% of patients in the SET group (2009: 6%; +13% [p <.001]) and also in 19% of patients in the INT group (2009: 35%; -16% [p <.001]). Later on, 29% of patients in the INT group were referred for SET (2009: 10%; +19% [p <.001]). Average costs of IC treatment per patient in 2011 were 6% lower than in 2009 ((sic)6885 vs. (sic)7300; p = .020).Conclusion: A 22% increase in adherence to SET as a first treatment strategy in Dutch patients with IC was attained between 2009 and 2011. This shift suggests successful SCM implementation resulting in lower costs for the national healthcare system. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.",

keywords = "Budget, Conservative treatment, Economic evaluation, Exercise, Exercise therapy, Intermittent claudication, Peripheral arterial disease, Walking, PERIPHERAL ARTERIAL-DISEASE, SUPERVISED EXERCISE THERAPY, RANDOMIZED CLINICAL-TRIAL, ENDOVASCULAR REVASCULARIZATION, PRACTICE GUIDELINES, OCCLUSIVE DISEASE, LOWER-EXTREMITY, HEALTH SYSTEMS, TASK-FORCE, MANAGEMENT",

author = "D. Hageman and Fokkenrood, {H. J. P.} and Essers, {P. P. M.} and Koelemay, {M. J. W.} and Breek, {J. C.} and Vahl, {A. C.} and Scheltinga, {M. R. M.} and Teijink, {J. A. W.}",

year = "2017",

month = jul,

doi = "10.1016/j.ejvs.2017.04.011",

language = "English",

volume = "54",

pages = "51--57",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "Elsevier Saunders",

number = "1",

}

TY - JOUR

T1 - Improved Adherence to a Stepped-care Model Reduces Costs of Intermittent Claudication Treatment in The Netherlands

AU - Hageman, D.

AU - Fokkenrood, H. J. P.

AU - Essers, P. P. M.

AU - Koelemay, M. J. W.

AU - Breek, J. C.

AU - Vahl, A. C.

AU - Scheltinga, M. R. M.

AU - Teijink, J. A. W.

PY - 2017/7

Y1 - 2017/7

N2 - Objective/Background: A previous budget impact analysis regarding a supervised exercise therapy (SET) first treatment strategy (stepped care model [SCM]) for Dutch patients with intermittent claudication (IC) showed a low referral rate in 2009, despite solid evidence of the effectiveness of SET programs. Recently, several campaigns have stimulated stakeholders in the field to adopt a SET first strategy in patients with IC. The aim of the present study was to reassess SCM adherence after a 2 year period.Methods: IC related invoices of patients in 2011 were obtained from a large Dutch health insurance company (3.5 million persons). Patients were divided into two groups based on their initial treatment. A SET group had started SET between 12 months before (initiated by general practitioner) and 3 months after (initiated by vascular surgeon) presentation at a vascular surgery outpatient clinic. An intervention (INT) group was treated by revascularisation within 3 months of outpatient presentation. Costs of IC treatment in this 2011 cohort were compared with the earlier 2009 cohort.Results: IC related invoices of 4135 patients were available. In 2011, the initial treatment was SET in 56% (2009: 34%; +22% [p <.001]) and INT in 44% (2009: 66%; -22% [p <.001]) of the IC population. Additional revascularisation was performed in 19% of patients in the SET group (2009: 6%; +13% [p <.001]) and also in 19% of patients in the INT group (2009: 35%; -16% [p <.001]). Later on, 29% of patients in the INT group were referred for SET (2009: 10%; +19% [p <.001]). Average costs of IC treatment per patient in 2011 were 6% lower than in 2009 ((sic)6885 vs. (sic)7300; p = .020).Conclusion: A 22% increase in adherence to SET as a first treatment strategy in Dutch patients with IC was attained between 2009 and 2011. This shift suggests successful SCM implementation resulting in lower costs for the national healthcare system. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

AB - Objective/Background: A previous budget impact analysis regarding a supervised exercise therapy (SET) first treatment strategy (stepped care model [SCM]) for Dutch patients with intermittent claudication (IC) showed a low referral rate in 2009, despite solid evidence of the effectiveness of SET programs. Recently, several campaigns have stimulated stakeholders in the field to adopt a SET first strategy in patients with IC. The aim of the present study was to reassess SCM adherence after a 2 year period.Methods: IC related invoices of patients in 2011 were obtained from a large Dutch health insurance company (3.5 million persons). Patients were divided into two groups based on their initial treatment. A SET group had started SET between 12 months before (initiated by general practitioner) and 3 months after (initiated by vascular surgeon) presentation at a vascular surgery outpatient clinic. An intervention (INT) group was treated by revascularisation within 3 months of outpatient presentation. Costs of IC treatment in this 2011 cohort were compared with the earlier 2009 cohort.Results: IC related invoices of 4135 patients were available. In 2011, the initial treatment was SET in 56% (2009: 34%; +22% [p <.001]) and INT in 44% (2009: 66%; -22% [p <.001]) of the IC population. Additional revascularisation was performed in 19% of patients in the SET group (2009: 6%; +13% [p <.001]) and also in 19% of patients in the INT group (2009: 35%; -16% [p <.001]). Later on, 29% of patients in the INT group were referred for SET (2009: 10%; +19% [p <.001]). Average costs of IC treatment per patient in 2011 were 6% lower than in 2009 ((sic)6885 vs. (sic)7300; p = .020).Conclusion: A 22% increase in adherence to SET as a first treatment strategy in Dutch patients with IC was attained between 2009 and 2011. This shift suggests successful SCM implementation resulting in lower costs for the national healthcare system. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

KW - Budget

KW - Conservative treatment

KW - Economic evaluation

KW - Exercise

KW - Exercise therapy

KW - Intermittent claudication

KW - Peripheral arterial disease

KW - Walking

KW - PERIPHERAL ARTERIAL-DISEASE

KW - SUPERVISED EXERCISE THERAPY

KW - RANDOMIZED CLINICAL-TRIAL

KW - ENDOVASCULAR REVASCULARIZATION

KW - PRACTICE GUIDELINES

KW - OCCLUSIVE DISEASE

KW - LOWER-EXTREMITY

KW - HEALTH SYSTEMS

KW - TASK-FORCE

KW - MANAGEMENT

U2 - 10.1016/j.ejvs.2017.04.011

DO - 10.1016/j.ejvs.2017.04.011

M3 - Article

C2 - 28539212

SN - 1078-5884

VL - 54

SP - 51

EP - 57

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 1

ER -