{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:02:03Z","timestamp":1789826523403,"version":"4.0.1"},"reference-count":118,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["NIHR135478"],"award-info":[{"award-number":["NIHR135478"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title>\n<jats:p>Peripheral artery disease is a common condition caused by narrowing\/blockage of the arteries, resulting in reduced blood supply. Peripheral artery disease is associated with an increased risk of vascular complications, but early treatment reduces mortality and morbidity. Leg ulcers are long-lasting wounds, usually treated by compression therapy. Compression therapy is not suitable for people with peripheral artery disease, as it can affect the arterial blood supply. In clinical practice, people with peripheral artery disease are identified by measurement of the ankle\u2013brachial pressure index using a sphygmomanometer and manual Doppler device. However, this method can be uncomfortable for people with leg ulcers and automated devices have been proposed as a more acceptable alternative. The objective of this appraisal was to summarise the clinical and cost-effectiveness evidence on the use of automated devices to detect peripheral artery disease in people with leg ulcers.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-2\"><jats:title>Methods<\/jats:title>\n<jats:p>\u2003<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-3\"><jats:title>Clinical effectiveness<\/jats:title>\n<jats:p>To identify reports of relevant studies, we searched major electronic databases and scrutinised the information supplied by the manufacturers of the automated devices under investigation. Due to the lack of evidence on people with leg ulcers, we considered evidence from studies of any design assessing automated devices versus an acceptable reference device in any population receiving ankle\u2013brachial pressure index assessment. We summarised information on diagnostic accuracy of the automated devices and level of agreement with the reference device. For each device, when data permit, we pooled data across studies by conducting random-effects meta-analyses using a Hierarchical Summary Receiving Operating Characteristics model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-4\"><jats:title>Cost-effectiveness<\/jats:title>\n<jats:p>An economic model comprising a decision tree (24 weeks) and Markov models to capture lifetime costs and quality-adjusted life-years associated with venous, arterial and mixed aetiology disease in leg ulcer patients. Analyses were conducted from a United Kingdom National Health Service and Personal Social Services perspective. Costs and quality-adjusted life-years were discounted at 3.5% per year. Deterministic and several probabilistic analyses were used to capture uncertainty surrounding a range of optimistic and pessimistic assumptions about the impact of automated tests on health outcomes (ulcer healing and requirement for invasive management of arterial disease).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-5\"><jats:title>Results<\/jats:title>\n<jats:p>\u2003<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-6\"><jats:title>Clinical effectiveness<\/jats:title>\n<jats:p>From the 116 records retrieved by the electronic searches, we included 24 studies evaluating five devices (BlueDop Vascular Expert, BOSO ABI-System 100, Dopplex Ability, MESI ankle\u2013brachial pressure index MD and WatchBP Office ABI). Two studies assessing people with leg ulcers found that automated devices often gave higher ankle\u2013brachial pressure index readings than manual Doppler (underestimation of arterial disease). In the 22 studies involving people without leg ulcers, automated devices generally demonstrated good specificity and moderate specificity. Meta-analysis of 12 studies showed a pooled sensitivity of 64% (95% confidence interval 57% to 71%) and a pooled specificity of 96% (95% confidence interval 92% to 98%) for detection of peripheral artery disease.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-7\"><jats:title>Cost-effectiveness<\/jats:title>\n<jats:p>Automated devices cost less than manual Doppler to deliver. However, increased risks of invasive treatment requirements for inappropriately compressed arterial\/mixed ulcers due to false-negative results, and increased healing times due to delayed compression of false-positive test results mean that in most scenarios manual Doppler was less costly and had slightly higher quality-adjusted life-years than automated devices. Results are highly uncertain, dependent on many assumptions and should be interpreted cautiously.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-8\"><jats:title>Limitations and conclusions<\/jats:title>\n<jats:p>The limited evidence identified for each automated device, especially in people with leg ulcers, and its clinical heterogeneity precludes any firm conclusions on the diagnostic performance and cost-effectiveness of these devices in clinical practice.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-9\"><jats:title>Study registration<\/jats:title>\n<jats:p>This study is registered as PROSPERO CRD42022327588.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-10\"><jats:title>Funding<\/jats:title>\n<jats:p>This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135478) and is published in full in <jats:italic>Health Technology Assessment<\/jats:italic>; Vol. 28, No. 37. See the NIHR Funding and Awards website for further award information.<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/twcg3912","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T14:23:16Z","timestamp":1724682196000},"page":"1-158","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Automated devices for identifying peripheral arterial disease in people with leg ulceration: an evidence synthesis and cost-effectiveness analysis"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9786-8118","authenticated-orcid":true,"given":"Dwayne","family":"Boyers","sequence":"first","affiliation":[{"name":"Health Economics Research Unit, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5182-884X","authenticated-orcid":true,"given":"Moira","family":"Cruickshank","sequence":"additional","affiliation":[{"name":"Health Services Research Unit, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6277-7972","authenticated-orcid":true,"given":"Lorna","family":"Aucott","sequence":"additional","affiliation":[{"name":"Health Services Research Unit, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1974-6318","authenticated-orcid":true,"given":"Charlotte","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Health Economics Research Unit, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-1795","authenticated-orcid":true,"given":"Paul","family":"Manson","sequence":"additional","affiliation":[{"name":"Health Services Research Unit, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1306-2572","authenticated-orcid":true,"given":"Paul","family":"Bachoo","sequence":"additional","affiliation":[{"name":"NHS Grampian, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7576-6751","authenticated-orcid":true,"given":"Miriam","family":"Brazzelli","sequence":"additional","affiliation":[{"name":"Health Economics Research Unit, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2024,8]]},"reference":[{"key":"key2024082619463000_ref1-bib1","article-title":"Lipid-lowering for peripheral arterial disease of the lower limb","volume":"2007","author":"Aung","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"key2024082619463000_ref2-bib2","doi-asserted-by":"crossref","first-page":"j5842","DOI":"10.1136\/bmj.j5842","article-title":"Peripheral artery disease","volume":"360","author":"Morley","year":"2018","journal-title":"BMJ"},{"key":"key2024082619463000_ref3-bib3","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.jvs.2006.12.037","article-title":"Inter-society consensus for the management of peripheral arterial disease (TASC II)","volume":"45","author":"Norgren","year":"2007","journal-title":"J Vasc Surg"},{"key":"key2024082619463000_ref4-bib4","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1093\/ije\/25.6.1172","article-title":"Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population","volume":"25","author":"Leng","year":"1996","journal-title":"Int J Epidemiol"},{"key":"key2024082619463000_ref5-bib5","article-title":"Compression for preventing recurrence of venous ulcers","volume":"2014","author":"Nelson","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"key2024082619463000_ref6-bib6","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1136\/bmj.294.6584.1389","article-title":"Chronic ulcer of the leg: clinical history","volume":"294","author":"Callam","year":"1987","journal-title":"Br Med J (Clin Res Ed)"},{"key":"key2024082619463000_ref7-bib7","first-page":"1902","article-title":"Venous leg ulcers","volume":"2016","author":"Nelson","year":"2016","journal-title":"BMJ Clin Evid"},{"key":"key2024082619463000_ref8-bib8","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1002\/bjs.5757","article-title":"Management of mixed arterial and venous leg ulcers","volume":"94","author":"Humphreys","year":"2007","journal-title":"Br J Surg"},{"key":"key2024082619463000_ref9-bib9","first-page":"32","article-title":"Assessing venous ulcer population characteristics and practices in a home care community","volume":"49","author":"Lorimer","year":"2003","journal-title":"Ostomy Wound Manage"},{"key":"key2024082619463000_ref10-bib10","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jtv.2008.11.002","article-title":"The prevalence, management and outcome for patients with lower limb ulceration identified in a wound care survey within one English health care district","volume":"18","author":"Vowden","year":"2009","journal-title":"J Tissue Viability"},{"key":"key2024082619463000_ref11-bib11","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1136\/bmj.290.6485.1855","article-title":"Chronic ulceration of the leg: extent of the problem and provision of care","volume":"290","author":"Callam","year":"1985","journal-title":"Br Med J (Clin Res Ed)"},{"key":"key2024082619463000_ref12-bib12","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD010182","article-title":"Compression for venous leg ulcers","volume":"11","author":"O\u2019Meara","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"key2024082619463000_ref13-bib13","volume-title":"Recommendations for Lower Limb Ulcers","author":"National Wound Care Strategy Programme","year":"2020"},{"key":"key2024082619463000_ref14-bib14","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1136\/bmj.295.6610.1382","article-title":"Hazards of compression treatment of the leg: an estimate from Scottish surgeons","volume":"295","author":"Callam","year":"1987","journal-title":"Br Med J (Clin Res Ed)"},{"key":"key2024082619463000_ref15-bib15","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1001\/jama.286.11.1317","article-title":"Peripheral arterial disease detection, awareness, and treatment in primary care","volume":"286","author":"Hirsch","year":"2001","journal-title":"JAMA"},{"key":"key2024082619463000_ref16-bib16","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1038\/nrcardio.2016.179","article-title":"Peripheral artery disease: epidemiology and global perspectives","volume":"14","author":"Fowkes","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"key2024082619463000_ref17-bib17","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1161\/CIRCRESAHA.121.320702","article-title":"Sex differences in peripheral artery disease","volume":"130","author":"Pabon","year":"2022","journal-title":"Circ Res"},{"key":"key2024082619463000_ref18-bib18","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1161\/CIRCRESAHA.116.303849","article-title":"Epidemiology of peripheral artery disease","volume":"116","author":"Criqui","year":"2015","journal-title":"Circ Res"},{"key":"key2024082619463000_ref19-bib19","doi-asserted-by":"crossref","first-page":"e003796","DOI":"10.1161\/JAHA.116.003796","article-title":"Peripheral artery disease prevalence and incidence estimated from both outpatient and inpatient settings among Medicare Fee-for-Service beneficiaries in the Atherosclerosis Risk in Communities (ARIC) study","volume":"6","author":"Kalbaugh","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"key2024082619463000_ref20-bib20","doi-asserted-by":"crossref","first-page":"e1020","DOI":"10.1016\/S2214-109X(19)30255-4","article-title":"Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis","volume":"7","author":"Song","year":"2019","journal-title":"Lancet Glob Health"},{"key":"key2024082619463000_ref21-bib21","doi-asserted-by":"crossref","first-page":"e045253","DOI":"10.1136\/bmjopen-2020-045253","article-title":"Cohort study evaluating the burden of wounds to the UK\u2019s National Health Service in 2017\/2018: update from 2012\/2013","volume":"10","author":"Guest","year":"2020","journal-title":"BMJ Open"},{"key":"key2024082619463000_ref22-bib22","volume-title":"Hospital Admitted Patient Care Activity 2020\u201321","author":"NHS","year":"2021"},{"key":"key2024082619463000_ref23-bib23","volume-title":"Peripheral Arterial Disease: Diagnosis and Management [CG147]","author":"National Institute for Health and Care Excellence","year":"2012"},{"key":"key2024082619463000_ref24-bib24","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1046\/j.1365-2702.2003.00859.x","article-title":"Leg ulcers: a review of their impact on daily life","volume":"13","author":"Persoon","year":"2004","journal-title":"J Clin Nurs"},{"key":"key2024082619463000_ref25-bib25","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1477-7525-5-44","article-title":"A systematic review on the impact of leg ulceration on patients\u2019 quality of life","volume":"5","author":"Herber","year":"2007","journal-title":"Health Qual Life Outcomes"},{"key":"key2024082619463000_ref26-bib26","doi-asserted-by":"crossref","first-page":"104329","DOI":"10.1016\/j.ijnurstu.2022.104329","article-title":"Barriers and enablers to physical activity in people with venous leg ulcers: a systematic review of qualitative studies","volume":"135","author":"Qiu","year":"2022","journal-title":"Int J Nurs Stud"},{"key":"key2024082619463000_ref27-bib27","doi-asserted-by":"crossref","first-page":"5161","DOI":"10.3390\/jcm10215161","article-title":"Automated measurements of ankle\u2013brachial index: a narrative review","volume":"10","author":"Danieluk","year":"2021","journal-title":"J Clin Med"},{"key":"key2024082619463000_ref28-bib28","volume-title":"How Should I Interpret Ankle Brachial Pressure Index (ABPI) Results?","author":"National Institute for Health and Care Excellence","year":"2021"},{"key":"key2024082619463000_ref29-bib29","volume-title":"Management of Chronic Venous Leg Ulcers [SIGN 120].","author":"Healthcare Improvement Scotland, Scottish Intercollegiate Guidelines Network","year":"2010"},{"key":"key2024082619463000_ref31-bib31","volume-title":"Mixed Aetiology Leg Ulcers","year":"2006"},{"key":"key2024082619463000_ref33-bib33","volume-title":"Leg Ulcer Management Guidelines","author":"Grothier","year":"2015"},{"key":"key2024082619463000_ref35-bib35","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.2","author":"Higgins","year":"2021"},{"key":"key2024082619463000_ref36-bib36","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med"},{"key":"key2024082619463000_ref37-bib37","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.7326\/M21-2234","article-title":"QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies","volume":"174","author":"Yang","year":"2021","journal-title":"Ann Intern Med"},{"key":"key2024082619463000_ref38-bib38","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/S0895-4356(98)00131-0","article-title":"The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus","volume":"51","author":"Verhagen","year":"1998","journal-title":"J Clin Epidemiol"},{"key":"key2024082619463000_ref39-bib39","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/jech.52.6.377","article-title":"The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions","volume":"52","author":"Downs","year":"1998","journal-title":"J Epidemiol Community Health"},{"key":"key2024082619463000_ref40-bib40","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/ebm.11.2.35","article-title":"The GATE frame: critical appraisal with pictures","volume":"11","author":"Jackson","year":"2006","journal-title":"Evid Based Med"},{"key":"key2024082619463000_ref41-bib41","volume-title":"Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 2.0","author":"Deeks","year":"2022"},{"key":"key2024082619463000_ref42-bib42","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1177\/1536867X0900900203","article-title":"Metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression","volume":"9","author":"Harbord","year":"2009","journal-title":"Stata J"},{"key":"key2024082619463000_ref44-bib44","first-page":"80","article-title":"Evaluation of an automated ankle brachial pressure index calculator in a nurse-led leg ulcer clinic","volume":"12","author":"Welsh","year":"2016","journal-title":"Wounds UK"},{"key":"key2024082619463000_ref45-bib45","volume-title":"Primary Health Care","author":"Green","year":"2020"},{"key":"key2024082619463000_ref46-bib46","volume-title":"Clinical Evaluation of the BlueDop Vascular Expert for Assessing Peripheral Arterial Disease","author":"National Library of Medicine","year":"2021"},{"key":"key2024082619463000_ref47-bib47","first-page":"357","article-title":"Oscillometric measurement of ankle\u2013brachial index in patients with suspected peripheral disease: comparison with Doppler method","volume":"139","author":"Diehm","year":"2009","journal-title":"Swiss Med Wkly"},{"key":"key2024082619463000_ref48-bib48","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1038\/hr.2015.124","article-title":"Automated plethysmographic measurement of the ankle\u2013brachial index: a comparison with the doppler ultrasound method","volume":"39","author":"Davies","year":"2016","journal-title":"Hypertens Res"},{"key":"key2024082619463000_ref49-bib49","doi-asserted-by":"crossref","first-page":"2050312116659088","DOI":"10.1177\/2050312116659088","article-title":"Non-invasive assessment of peripheral arterial disease: automated ankle\u2013brachial index measurement and pulse volume analysis compared to duplex scan","volume":"4","author":"Lewis","year":"2016","journal-title":"SAGE Open Med"},{"key":"key2024082619463000_ref50-bib50","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/14017431.2022.2069855","article-title":"Validation of an automated measurement method for determination of the ankle\u2013brachial index","volume":"56","author":"Zebari","year":"2022","journal-title":"Scand Cardiovasc J"},{"key":"key2024082619463000_ref51-bib51","volume-title":"A Comparison Between Dopplex Ability and the Doppler Method for Obtaining Ankle Brachial Pressures","author":"Lewis","year":"2010"},{"key":"key2024082619463000_ref52-bib52","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1038\/s41440-020-0403-7","article-title":"Comparison of ankle\u2013brachial index measured with an automatic oscillometric method with the standard continuous Doppler method and effect of rest time before the measure in patients with exertional limb symptoms","volume":"43","author":"Boilley","year":"2020","journal-title":"Hypertens Res"},{"key":"key2024082619463000_ref53-bib53","doi-asserted-by":"crossref","first-page":"305","DOI":"10.2147\/VHRM.S106534","article-title":"Detection of peripheral arterial disease with an improved automated device: comparison of a new oscillometric device and the standard Doppler method","volume":"12","author":"\u0160pan","year":"2016","journal-title":"Vasc Health Risk Manag"},{"key":"key2024082619463000_ref54-bib54","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.pcd.2019.09.005","article-title":"Non-invasive vascular assessment in people with type 2 diabetes: diagnostic performance of plethysmographic-and-Doppler derived ankle brachial index, toe brachial index, and pulse volume wave analysis for detection of peripheral arterial disease","volume":"14","author":"Babaei","year":"2020","journal-title":"Prim Care Diabetes"},{"key":"key2024082619463000_ref55-bib55","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4103\/jfmpc.jfmpc_102_21","article-title":"Assessment of peripheral artery disease risk in building construction workers by ankle\u2013brachial index measurement with automated oscillometric and hand-held Doppler device","volume":"11","author":"Verma","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"key2024082619463000_ref56-bib56","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1038\/hr.2011.53","article-title":"Automated determination of the ankle\u2013brachial index using an oscillometric blood pressure monitor: validation vs. Doppler measurement and cardiovascular risk factor profile","volume":"34","author":"Kollias","year":"2011","journal-title":"Hypertens Res"},{"key":"key2024082619463000_ref57-bib57","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/jum.14370","article-title":"Novel assessment (BlueDop) device for detection of lower limb arterial disease: a prospective comparative study","volume":"37","author":"Kordzadeh","year":"2018","journal-title":"J Ultrasound Med"},{"key":"key2024082619463000_ref58-bib58","doi-asserted-by":"crossref","first-page":"227","DOI":"10.5507\/bp.2018.046","article-title":"Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients","volume":"163","author":"Homza","year":"2019","journal-title":"Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"},{"key":"key2024082619463000_ref59-bib59","first-page":"176","article-title":"The potential role of oscillometric devices for ankle\u2013brachial index measurements in clinical practice","volume":"159","author":"Jarai","year":"2018","journal-title":"Orv Hetil"},{"key":"key2024082619463000_ref60-bib60","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1080\/17434440.2018.1431121","article-title":"Accuracy and repeatability of the Dopplex Ability","volume":"15","author":"Millen","year":"2018","journal-title":"Expert Rev Med Devices"},{"key":"key2024082619463000_ref61-bib61","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.jvs.2020.05.077","article-title":"Diagnostic accuracy of automated oscillometric determination of the ankle\u2013brachial index in peripheral artery disease","volume":"73","author":"Hageman","year":"2021","journal-title":"J Vasc Surg"},{"key":"key2024082619463000_ref62-bib62","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.avsg.2019.10.092","article-title":"Proficiency of medical students at obtaining pressure measurement readings using automated ankle and toe measuring devices for diagnosis of lower extremity peripheral artery disease","volume":"65","author":"Catillon","year":"2020","journal-title":"Ann Vasc Surg"},{"key":"key2024082619463000_ref63-bib63","doi-asserted-by":"crossref","first-page":"012","DOI":"10.24966\/NIVI-7400\/100012","article-title":"Comparison of ankle brachial index ABI measurement between a new oscillometric device MESI ABPI Md and the standard Doppler method","volume":"4","author":"Varetto","year":"2019","journal-title":"Non Invasive Vascular Investig"},{"key":"key2024082619463000_ref64-bib64","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.appr.2018.10.001","article-title":"Comparison of two automatic oscillometers vs the traditional method with Doppler probe in the determination of the ankle brachial index","volume":"1","author":"Raya","year":"2019","journal-title":"Atencion Primaria Practica"},{"key":"key2024082619463000_ref65-bib65","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1038\/hr.2012.120","article-title":"Automated oscillometric measurement of the ankle\u2013brachial index in patients with coronary artery disease","volume":"36","author":"Sinski","year":"2013","journal-title":"Hypertens Res"},{"key":"key2024082619463000_ref66-bib66","first-page":"256","article-title":"A novel oscillometric device for peripheral arterial disease screening in everyday practice. The Czech-post MONICA study","volume":"30","author":"Wohlfahrt","year":"2011","journal-title":"Int Angiol"},{"key":"key2024082619463000_ref67-bib67","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3109\/08037051.2013.876796","article-title":"Concordance between automated oscillometric measurement of ankle\u2013brachial index and traditional measurement by eco-Doppler in patients without peripheral artery disease","volume":"23","author":"Rodriguez-Roca","year":"2014","journal-title":"Blood Press"},{"key":"key2024082619463000_ref68-bib68","first-page":"34","article-title":"Improving assessment and management of lower limb wounds","volume":"33","author":"Boast","year":"2019","journal-title":"J Community Nurs"},{"key":"key2024082619463000_ref69-bib69","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1471-2296-15-69","article-title":"Current utility of the ankle\u2013brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening","volume":"15","author":"Davies","year":"2014","journal-title":"BMC Fam Pract"},{"key":"key2024082619463000_ref71-bib71","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s41669-018-0076-1","article-title":"Systematic review of economic models used to compare techniques for detecting peripheral arterial disease","volume":"3","author":"Moloney","year":"2019","journal-title":"PharmacoEcon Open"},{"key":"key2024082619463000_ref72-bib72","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/1358863X17745371","article-title":"Cost-effectiveness analysis of asymptomatic peripheral artery disease screening with the ABI test","volume":"23","author":"Itoga","year":"2018","journal-title":"Vasc Med"},{"key":"key2024082619463000_ref73-bib73","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s41669-019-0148-x","article-title":"A systematic review of model-based economic evaluations of treatments for venous leg ulcers","volume":"4","author":"Layer","year":"2020","journal-title":"PharmacoEcon Open"},{"key":"key2024082619463000_ref74-bib74","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1186\/s12913-018-3234-3","article-title":"Cost-effectiveness analysis of guideline-based optimal care for venous leg ulcers in Australia","volume":"18","author":"Cheng","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"key2024082619463000_ref75-bib75","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1007\/s11136-005-2751-9","article-title":"Quality of life of people with venous leg ulcers: a comparison of the discriminative and responsive characteristics of two generic and a disease specific instruments","volume":"14","author":"Iglesias","year":"2005","journal-title":"Qual Life Res"},{"key":"key2024082619463000_ref76-bib76","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1503\/cmaj.1041441","article-title":"Leg-ulcer care in the community, before and after implementation of an evidence-based service","volume":"172","author":"Harrison","year":"2005","journal-title":"CMAJ"},{"key":"key2024082619463000_ref77-bib77","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.ijnurstu.2008.12.012","article-title":"Factors associated with recurrence of venous leg ulcers: a survey and retrospective chart review","volume":"46","author":"Finlayson","year":"2009","journal-title":"Int J Nurs Stud"},{"key":"key2024082619463000_ref78-bib78","doi-asserted-by":"crossref","first-page":"68","DOI":"10.12968\/jowc.2018.27.2.68","article-title":"Cost-effectiveness of using a collagen-containing dressing plus compression therapy in non-healing venous leg ulcers","volume":"27","author":"Guest","year":"2018","journal-title":"J Wound Care"},{"key":"key2024082619463000_ref79-bib79","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1185\/030079906X167705","article-title":"Modelling the cost-utility of bio-electric stimulation therapy compared to standard care in the treatment of elderly patients with chronic non-healing wounds in the UK","volume":"23","author":"Clegg","year":"2007","journal-title":"Curr Med Res Opin"},{"key":"key2024082619463000_ref80-bib80","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/iwj.12814","article-title":"Venous leg ulcer management in clinical practice in the UK: costs and outcomes","volume":"15","author":"Guest","year":"2018","journal-title":"Int Wound J"},{"key":"key2024082619463000_ref81-bib81","first-page":"1","article-title":"Compression stockings for the prevention of venous leg ulcer recurrence: a Health Technology Assessment","volume":"19","author":"Health Quality Ontario","year":"2019","journal-title":"Ontario Health Technol Assess Ser"},{"key":"key2024082619463000_ref82-bib82","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1186\/1472-6963-12-346","article-title":"Cost-effectiveness of compression technologies for evidence-informed leg ulcer care: results from the Canadian Bandaging Trial","volume":"12","author":"Pham","year":"2012","journal-title":"BMC Health Serv Res"},{"key":"key2024082619463000_ref83-bib83","doi-asserted-by":"crossref","first-page":"705","DOI":"10.2217\/cer-2020-0030","article-title":"Venous stenting for patients with outflow obstruction and leg ulcers: cost-effectiveness and budget impact analyses","volume":"9","author":"Rognoni","year":"2020","journal-title":"J Comp Eff Res"},{"key":"key2024082619463000_ref84-bib84","doi-asserted-by":"crossref","first-page":"235","DOI":"10.12968\/jowc.2020.29.4.235","article-title":"Cost-effectiveness of superabsorbent wound dressing versus standard of care in patients with moderate-to-highly exuding leg ulcers","volume":"29","author":"Velickovic","year":"2020","journal-title":"J Wound Care"},{"key":"key2024082619463000_ref85-bib85","doi-asserted-by":"crossref","first-page":"174","DOI":"10.12968\/jowc.2020.29.3.174","article-title":"Evaluation of a superabsorbent wound dressing, patient and clinician perspective: a case series","volume":"29","author":"Atkin","year":"2020","journal-title":"J Wound Care"},{"key":"key2024082619463000_ref86-bib86","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/iwj.12006","article-title":"A new methodology for costing wound care","volume":"10","author":"Harding","year":"2013","journal-title":"Int Wound J"},{"key":"key2024082619463000_ref87-bib87","first-page":"1","article-title":"Skin substitutes for adults with diabetic foot ulcers and venous leg ulcers: a health technology assessment","volume":"21","author":"Health Quality Ontario","year":"2021","journal-title":"Ontario Health Technol Assess Ser"},{"key":"key2024082619463000_ref88-bib88","doi-asserted-by":"crossref","first-page":"544","DOI":"10.12968\/jowc.2021.30.7.544","article-title":"Cost-effectiveness of using intermittent pneumatic compression to manage hard-to-heal venous leg ulcers in the UK","volume":"30","author":"Guest","year":"2021","journal-title":"J Wound Care"},{"key":"key2024082619463000_ref89-bib89","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/iwj.12603","article-title":"Health economic burden that different wound types impose on the UK\u2019s National Health Service","volume":"14","author":"Guest","year":"2017","journal-title":"Int Wound J"},{"key":"key2024082619463000_ref90-bib90","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/iwj.13645","article-title":"Cost-effectiveness analysis of superabsorbent wound dressings in patients with moderate-to-highly exuding leg ulcers in Germany","volume":"19","author":"Velickovic","year":"2022","journal-title":"Int Wound J"},{"key":"key2024082619463000_ref91-bib91","volume-title":"Leg Ulcer: Venous","author":"National Institute for Health and Care Excellence","year":"2021"},{"key":"key2024082619463000_ref93-bib93","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta23240","article-title":"Early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration: the EVRA RCT","volume":"23","author":"Gohel","year":"2019","journal-title":"Health Technol Assess"},{"key":"key2024082619463000_ref94-bib94","article-title":"Clinical presentation of lower extremity arterial disease (LEAD)","volume":"16","author":"Diaconu","year":"2018","journal-title":"E-J Cardiol Pract"},{"key":"key2024082619463000_ref95-bib95","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/01.ASW.0000822628.82131.1d","article-title":"Diagnostic accuracy of ankle\u2013brachial pressure index compared with Doppler arterial waveforms for detecting peripheral arterial disease: a systematic review","volume":"35","author":"Kashetsky","year":"2022","journal-title":"Adv Skin Wound Care"},{"key":"key2024082619463000_ref96-bib96","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1177\/0003319712464814","article-title":"Photoplethysmography and continuous-wave Doppler ultrasound as a complementary test to ankle\u2013brachial index in detection of stenotic peripheral arterial disease","volume":"64","author":"Ro du","year":"2013","journal-title":"Angiology"},{"key":"key2024082619463000_ref97-bib97","doi-asserted-by":"crossref","first-page":"3908","DOI":"10.1007\/s00330-020-06696-x","article-title":"Concomitant chronic venous insufficiency in patients with peripheral artery disease: insights from MR angiography","volume":"30","author":"Ammermann","year":"2020","journal-title":"Eur Radiol"},{"key":"key2024082619463000_ref99-bib99","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1001\/jamasurg.2020.3845","article-title":"Long-term clinical and cost-effectiveness of early endovenous ablation in venous ulceration: a randomized clinical trial","volume":"155","author":"Gohel","year":"2020","journal-title":"JAMA Surg"},{"key":"key2024082619463000_ref100-bib100","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1136\/bmj.39216.542442.BE","article-title":"Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial","volume":"335","author":"Gohel","year":"2007","journal-title":"BMJ"},{"key":"key2024082619463000_ref101-bib101","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.ejvs.2015.10.022","article-title":"The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease","volume":"51","author":"Sigvant","year":"2016","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"key2024082619463000_ref102-bib102","doi-asserted-by":"crossref","first-page":"e001926","DOI":"10.1161\/JAHA.115.001926","article-title":"Population-based study of incidence of acute abdominal aortic aneurysms with projected impact of screening strategy","volume":"4","author":"Howard","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"key2024082619463000_ref103-bib103","volume-title":"National Life Tables: UK","author":"Office for National Statistics","year":"2021"},{"key":"key2024082619463000_ref104-bib104","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2147\/VHRM.S209241","article-title":"The burden of critical limb ischemia: a review of recent literature","volume":"15","author":"Duff","year":"2019","journal-title":"Vasc Health Risk Manag"},{"key":"key2024082619463000_ref105-bib105","doi-asserted-by":"crossref","first-page":"216","DOI":"10.2215\/CJN.05600515","article-title":"CKD and acute and long-term outcome of patients with peripheral artery disease and critical limb ischemia","volume":"11","author":"L\u00fcders","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"key2024082619463000_ref106-bib106","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1093\/eurheartj\/ehv006","article-title":"Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence","volume":"36","author":"Reinecke","year":"2015","journal-title":"Eur Heart J"},{"key":"key2024082619463000_ref107-bib107","first-page":"87","article-title":"Performing a Doppler assessment","volume":"5","author":"Beldon","year":"2010","journal-title":"Wound Essentials"},{"key":"key2024082619463000_ref108-bib108","volume-title":"Unit Costs of Health and Social Care 2021","author":"Jones","year":"2021"},{"key":"key2024082619463000_ref109-bib109","volume-title":"National Cost Collection for the NHS","author":"NHS","year":"2021"},{"key":"key2024082619463000_ref111-bib111","doi-asserted-by":"crossref","first-page":"e0244851","DOI":"10.1371\/journal.pone.0244851","article-title":"Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease","volume":"16","author":"Ezeofor","year":"2021","journal-title":"PLOS ONE"},{"key":"key2024082619463000_ref112-bib112","doi-asserted-by":"crossref","first-page":"e056790","DOI":"10.1136\/bmjopen-2021-056790","article-title":"Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England","volume":"12","author":"Urwin","year":"2022","journal-title":"BMJ Open"},{"key":"key2024082619463000_ref113-bib113","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta19980","article-title":"Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis","volume":"19","author":"Wade","year":"2015","journal-title":"Health Technol Assess"},{"key":"key2024082619463000_ref114-bib114","first-page":"e299","article-title":"The demographic and clinical characteristics of those with and without diabetes that undergo a lower extremity amputation in Glasgow, UK","volume":"101","author":"Davie-Smith","year":"2015","journal-title":"Physiotherapy"},{"key":"key2024082619463000_ref115-bib115","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jvs.2005.04.015","article-title":"Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients","volume":"42","author":"Taylor","year":"2005","journal-title":"J Vasc Surg"},{"key":"key2024082619463000_ref116-bib116","volume-title":"Unit Costs of Health and Social Care 2019\/20","author":"Curtis","year":"2019"},{"key":"key2024082619463000_ref117-bib117","doi-asserted-by":"crossref","first-page":"43S","DOI":"10.1016\/j.jvs.2010.01.076","article-title":"Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis","volume":"51","author":"Forbes","year":"2010","journal-title":"J Vasc Surg"},{"key":"key2024082619463000_ref118-bib118","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/s-0032-1324738","article-title":"Critical limb ischemia and its impact on patient health preferences and quality of life \u2013 an international study","volume":"21","author":"Pisa","year":"2012","journal-title":"Int J Angiol"},{"key":"key2024082619463000_ref119-bib119","doi-asserted-by":"crossref","first-page":"8471","DOI":"10.1080\/09638288.2021.2015628","article-title":"Health-related quality of life in patients with lower limb amputation \u2013 an assessment of the measurement properties of EQ-5D-3L and EQ-5D-5L using data from the Swedish Amputation and Prosthetics Registry","volume":"44","author":"Ernstsson","year":"2021","journal-title":"Disabil Rehabil"},{"key":"key2024082619463000_ref120-bib120","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00547-006-2073-y","article-title":"von der Schulenburg JMG. Cost\u2013utility analysis of treating severe peripheral arterial occlusive disease","volume":"15","author":"Holler","year":"2006","journal-title":"Int J Angiol"},{"key":"key2024082619463000_ref121-bib121","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta18100","article-title":"Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis","volume":"18","author":"Simpson","year":"2014","journal-title":"Health Technol Assess"},{"key":"key2024082619463000_ref122-bib122","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s40273-019-00844-y","article-title":"TECH-VER: a verification checklist to reduce errors in models and improve their credibility","volume":"37","author":"B\u00fcy\u00fckkaramikli","year":"2019","journal-title":"PharmacoEcon"},{"key":"key2024082619463000_ref123-bib123","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s40273-014-0186-2","article-title":"Avoiding and identifying errors and other threats to the credibility of health economic models","volume":"32","author":"Tappenden","year":"2014","journal-title":"PharmacoEcon"},{"key":"key2024082619463000_ref124-bib124","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1038\/hr.2012.83","article-title":"Automated oscillometric determination of the ankle\u2013brachial index: a systematic review and meta-analysis","volume":"35","author":"Verberk","year":"2012","journal-title":"Hypertens Res"},{"key":"key2024082619463000_ref125-bib125","doi-asserted-by":"crossref","first-page":"e12994","DOI":"10.1111\/ijcp.12994","article-title":"The accuracy of an oscillometric ankle\u2013brachial index in the diagnosis of lower limb peripheral arterial disease: a systematic review and meta-analysis","volume":"71","author":"Herr\u00e1iz-Adillo","year":"2017","journal-title":"Int J Clin Pract"},{"key":"key2024082619463000_ref126-bib126","doi-asserted-by":"crossref","first-page":"141","DOI":"10.11613\/BM.2015.015","article-title":"Understanding Bland Altman analysis","volume":"25","author":"Giavarina","year":"2015","journal-title":"Biochem Med (Zagreb)"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2045760","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/TWCG3912\/TWCG3912.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2045760","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T14:24:15Z","timestamp":1724682255000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/TWCG3912"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":118,"alternative-id":["10.3310\/TWCG3912"],"URL":"https:\/\/doi.org\/10.3310\/twcg3912","relation":{},"ISSN":["2046-4924"],"issn-type":[{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"},{"value":"04-2022","name":"contractual_start_date","label":"contractual_start_date","group":{"name":"article_history","label":"Article History"}},{"value":"10-2022","name":"editorial_review_begun","label":"editorial review begun","group":{"name":"article_history","label":"Article History"}},{"value":"08-2023","name":"accepted_for_publication","label":"Accepted for publication","group":{"name":"article_history","label":"Article History"}}]}}