Decision-Making in Critical Limb Ischemia: A Markov Simulation.

ABSTRACT:

Background

Critical limb ischemia (CLI) is a feared complication of peripheral vascular disease that often requires surgical management and may require amputation of the affected limb. We developed a decision model to inform clinical management for a 63-year-old woman with CLI and multiple medical comorbidities, including advanced heart failure and diabetes.

Methods

We developed a Markov decision model to evaluate 4 strategies: amputation, surgical bypass, endovascular therapy (e.g. stent or revascularization), and medical management. We measured the impact of parameter uncertainty using 1-way, 2-way, and multiway sensitivity analyses.

Results

In the base case, endovascular therapy yielded similar discounted quality-adjusted life months (26.50 QALMs) compared with sur

SUBMITTER: Deutsch AJ 

PROVIDER: S-EPMC5643229 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature