{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:32:54Z","timestamp":1788312774851,"version":"build-2803163510"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,12,17]]},"abstract":"\n Background<\/jats:title>\n \n Both supervised exercise (\n SE<\/jats:styled-content>\n ) and stenting (\n ST<\/jats:styled-content>\n ) improve functional status, symptoms, and quality of life compared with optimal medical care (\n OMC<\/jats:styled-content>\n ) in patients with claudication. The relative cost\u2010effectiveness of these strategies is not well defined.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n The Claudication: Exercise Versus Endoluminal Revascularization (\n CLEVER<\/jats:styled-content>\n ) study randomized patients with claudication due to aortoiliac stenosis to a 6\u2010month\n SE<\/jats:styled-content>\n program, to\n ST<\/jats:styled-content>\n , or to\n OMC<\/jats:styled-content>\n . Participants who completed 6\u2010month follow\u2010up (n=98) were included in a health economic analysis through 18\u00a0months. Costs were assessed using resource\u2010based methods and hospital billing data. Quality\u2010adjusted life\u2010years were estimated using the\n EQ<\/jats:styled-content>\n \u20105D. Markov modeling based on the in\u2010trial results was used to explore the impact of assumptions about the longer term durability of observed differences in quality of life. Through 18\u00a0months, mean healthcare costs were $5178, $9804, and $14\u00a0590 per patient for\n OMC<\/jats:styled-content>\n ,\n SE<\/jats:styled-content>\n , and\n ST<\/jats:styled-content>\n , respectively. Measured quality\u2010adjusted life\u2010years through 18\u00a0months were 1.04, 1.16, and 1.20. In our base case analysis, which assumed that observed differences in quality of life would dissipate after 5\u00a0years, the incremental cost\u2010effectiveness ratios were $24\u00a0070 per quality\u2010adjusted life\u2010year gained for\n SE<\/jats:styled-content>\n versus\n OMC<\/jats:styled-content>\n , $41\u00a0376 for\n ST<\/jats:styled-content>\n versus\n OMC<\/jats:styled-content>\n , and $122\u00a0600 for\n ST<\/jats:styled-content>\n versus\n SE<\/jats:styled-content>\n . If the treatment effect of\n ST<\/jats:styled-content>\n was assumed to be more durable than that of\n SE<\/jats:styled-content>\n , the incremental cost\u2010effectiveness ratio for\n ST<\/jats:styled-content>\n versus\n SE<\/jats:styled-content>\n became more favorable.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Both\n SE<\/jats:styled-content>\n and\n ST<\/jats:styled-content>\n are economically attractive by\n US<\/jats:styled-content>\n standards relative to\n OMC<\/jats:styled-content>\n for the treatment of claudication in patients with aortoiliac disease.\n ST<\/jats:styled-content>\n is more expensive than\n SE<\/jats:styled-content>\n , with uncertain incremental benefit.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL:\n www.clinicaltrials.gov<\/jats:ext-link>\n , Unique identifier: NCT00132743.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.114.001233","type":"journal-article","created":{"date-parts":[[2014,11,12]],"date-time":"2014-11-12T00:06:33Z","timestamp":1415750793000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Cost\u2010Effectiveness of Supervised Exercise, Stenting, and Optimal Medical Care for Claudication: Results From the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) Trial"],"prefix":"10.1161","volume":"3","author":[{"given":"Matthew R.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Harvard Clinical Research Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Apruzzese","sequence":"additional","affiliation":[{"name":"Harvard Clinical Research Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin 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