How does the cost of treating critical limb-threatening ischemia (CLTI) in the U.S. stack up to cancer care? That was the question at the heart of research conducted by Richard W. Walsh, MD, and colleagues at the University of Texas Health Science Center in San Antonio, Texas, to be presented during the 2025 Vascular Annual Meeting (VAM) Plenary 2, Wednesday (10:20–11:15 a.m.) on the First Floor (Great Hall A). Ahead of the presentation, Walsh spoke to VS@ VAM to unpack the findings and how he believes they could hold important lessons for vascular care.
VS: What is the background to the research?
CLTI is a severe disease that is complicated by multiple medical comorbidities, each of which add cost for patients. These typically require multiple operations and reoperations over the course of a progressively debilitating disease, culminating in either limb salvage, amputation or eventual death.
On the other hand, we have seen how multidisciplinary care, research and targeted interventions have improved cancer survival and likely cost over time. The top four cancers in the U.S. are well studied and have strong data-driven treatment plans for most scenarios, offering a juxtaposition to CLTI patients, whose treatments can be highly provider, patient and region dependent. Comparing the costs of these two very different treatment approaches serves to illustrate the severity of CLTI costs, using cancer costs as a benchmark.
VS: What were your findings?
Within the limitations of the study, based on available data published on cancer and CLTI within the U.S., the annual per capita cost of CLTI was greater than the top four cancers—breast, prostate, colorectal and lung—in various stages, with multiple factors that increase this including medical comorbidities. Our manuscript references how renal or cardiac complications add a $11–20,000 price tag to any hospitalization.
VS: What do you expect is driving this?
CLTI is a chronic, uncurable disease with patients requiring multiple interventions, operations and reoperations. As endovascular approaches improve and innovate, these new technologies likely bring an increased element of expense. The latest peer-reviewed data are from 2011 and only show a difference of around $500 between surgical and endovascular approaches. We speculate the true cost of CLTI is greater.
Another factor involves the severity of cancer compared to CLTI. To most patients, cancer is a serious and potentially deadly disease. Effective screening programs are under constant study to catch cancers at a lower stage. Strong multidisciplinary teams are activated and provide continuity of care to the patients as they journey through cancer care, whereas most centers seeing CLTI patients do not have this level of resource.
Unfortunately, screening for—and finding early signs of—CLTI remains a challenge where literature has demonstrated patients with signs of CLTI are missed in the primary care setting.
Finally, CLTI is a chronic disease that continues to worsen over time, whereas early-stage cancers may be curable. This curative treatment leads to long and relatively healthy lives where the only remaining expenditures will be continued surveillance.
VS: What do you hope the vascular community will take away from the research?
This study does not aim to detract from the critical work and strong need for cancer research and innovation, with cancer research having led to revolutionary outcomes that have translated to reduced healthcare costs. Additional research aimed at prevention, treatment, management and screening can potentially offer additional patient outcome benefits and, by extension, reduced costs.
Cancer is feared by patients for relatable reasons. In the clinical setting, we have not seen an equal level of concern coming from CLTI patients, especially in early disease. At the late stage of the disease, where patients are afflicted by tissue loss, independence loss, and complications from treatments or comorbid conditions, we start to see greater understanding surrounding the severity of CLTI. Improvement in awareness of CLTI may provide a benefit to patient outcomes in the form of prevention or earlier disease recognition and this may lead to cost savings.
Furthermore, strong efforts are taken in cancer centers to ensure a patient has funding and means to avoid being lost to follow-up. Having a combination of vascular surgeons, wound care specialists and medical physicians with expertise in cardiac and renal complications within one clinic would allow for streamlined care to patients with CLTI.
As clinicians, we have all seen patients with poorly controlled comorbid disease. If this can be better managed, this offers a small start to improving outcomes. Investing in proper chronic disease management can provide a measure for cost reductions in the form of lengthening intervals between operations and, in theory, can reduce the number of total operations.
Finally, continued efforts on the development of evidence-based guidelines are needed.
