Results (
Thai) 2:
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Conclusions
Naftidrofuryl oxalate and cilostazol are both effective treatments for this patient population, with minimal SAEs; however, naftidrofuryl oxalate is the only treatment with an incremental cost per QALY gained below £20,000 compared with no vasoactive drug, with an estimated incremental cost per QALY gained of £6070.
Implications for service provision
Provision of these drugs does not usually engender significant additional management costs, as these drugs would be provided alongside a range of other treatments for PAD and its risk factors and there is no evidence that they impact upon disease progression. Therefore, the burden upon the NHS is generally in terms of the drug acquisition cost only. Within England and Wales the vasoactive drugs assessed within this report are available to be prescribed to patients with IC, although there may be restrictions to their use due to local policies. Therefore, if these drugs were to be recommended, prescription rates of the drugs may rise considerably.
Suggested research priorities
A trial comparing the long-term effectiveness (beyond 24 weeks) of cilostazol, naftidrofuryl oxalate and placebo would be beneficial, which should collect utility data as well as walking distance outcomes. The health economic model currently assumes that the effectiveness of the vasoactive drugs is maintained while the patients are taking the drugs; however, this should be tested within a trial. It would also be useful to compare the outcomes associated with naftidrofuryl oxalate with those associated with supervised exercise programmes and other treatments, such as angioplasty. Importantly, there are currently no long-term safety trials for naftidrofuryl oxalate; however, clinical experts suggest that the mechanism of the drugs is such that no long-term impacts on cardiovascular events or mortality would be expected. Any such trials are likely to be costly due to the sample size and length of follow-up required to detect any differences between the two arms for these events.
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