Point-of-care duplex ultrasound (PAD-scan) is a cost-effective test for the detection of peripheral arterial disease (PAD) in patients with diabetes. This is the conclusion of a study recently published online in Annals of Surgery.
Authors Pasha Normahani (Imperial College NHS Healthcare Trust, London, UK) and colleagues write that PAD is a risk factor for cardiovascular disease, diabetic foot ulceration, and amputation in diabetic patients. They state that diagnosis enables optimisation of therapies to manage these risks, and highlight that PAD-scan can be performed by frontline staff and has been shown to be the most accurate bedside test. However, they stress that its cost-effectiveness has not been investigated.
Normahani et al detail that in the present study, a Markov model was constructed to estimate the health outcomes and costs over five years of different testing strategies applied to a cohort of diabetic patients. Bedside tests investigated were PAD-scan, ankle-brachial pressure index (ABPI), toe-brachial pressure index (TBPI), audible and visual Doppler, transcutaneous pressure of oxygen (TcPO2), and pulse palpitation, they specify. The authors note that health outcomes were incidence of new diabetic foot ulcer, major cardiovascular events, amputation, death, and diabetic foot ulcer healing rates.
“PAD-scan was the most cost-effective bedside test with an incremental cost-effectiveness ratio of £11,391/quality adjusted life years (QALY),” the authors communicate, adding that PAD-scan superiority in incremental cost-effectiveness ratio occurred at a PAD prevalence threshold of 0.24. Furthermore, they report that PAD-scan had the highest probability (78.7%) of having the greatest net benefit at a willingness to pay threshold of £20,000 per QALY. Finally, they reveal that the test reduced the number of amputations by 24% and the number of cardiovascular deaths by 10% over five years, compared to TBPI—the next best alternative.
Speaking to Vascular News about the significance of the team’s findings, Normahani commented: “Our results encouragingly suggest that point-of-care duplex ultrasound is accurate, cost-effective, and that its adoption may improve clinical outcomes. These results require external validation but provide a promising target for future research aiming to address the high burden of amputation and mortality in this group of patients.”