Cost-effectiveness of differing perioperative beta-blockade strategies in vascular surgery XXXX .

@entity1 @entity1406 @entity7368 @entity583 @entity2165 @entity1028 @entity204 @entity2179
OBJECTIVES: To determine the incremental value of different strategies of both oral and intravenous beta-blockade during the perioperative period in high-risk vascular @entity1 in reducing costs and improving outcomes. DESIGN: Decision analytic model incorporating costs from provider's perspective INTERVENTIONS: Five perioperative strategies in @entity1 undergoing @entity1028 surgery: (1). no routine beta-blockade, (2). preoperative oral @entity2179 for 7 days followed by perioperative intravenous @entity1406 and oral @entity2179 based on preoperative titration, (3). immediate preoperative @entity2165 with postoperative intravenous then oral @entity2165 , (4). intraoperative @entity7368 and postoperative intravenous then oral @entity2165 , and (5). intraoperative and 18 hours of postoperative @entity7368 then @entity2165 . MEASUREMENTS AND MAIN RESULTS: Perioperative @entity204 was associated with a net increase of US dollars 21909 in charges to Medicare, whereas sustaining a perioperative @entity583 was associated with a net increase in charges of US dollars 15000. There is a net hospital saving of US dollars 500 using a strategy of titration of an oral beta-blocker medication for a minimum of 7 days, with a net increase in efficacy of 0.0304. All of the strategies involving acute perioperative blockade were associated with a net cost savings and increase in efficacy, although less than the strategy involving preoperative oral titration. CONCLUSION: Perioperative beta-blockade is both cost effective as well as efficacious from a short-term provider perspective. The optimal strategy of treatment for @entity1 who do not present to surgery already on beta-blockers requires further study, although all strategies save money even accounting for pharmaceutical costs.
