A contemporary paradigm for value-based medicine in peripheral artery disease.

Abstract

Peripheral artery disease (PAD) imposes significant clinical and economic burdens. Current fee-for-service models incentivize volume rather than outcomes, highlighting the need for value-based medicine (VBM) approaches. This review evaluates contemporary strategies for integrating VBM into PAD management, focusing on enhancing patient outcomes, optimizing resource use, and reducing health care expenditures. We undertook a narrative review of the English-language literature by searching PubMed, Google Scholar, and professional society websites through April 2025 with the terms peripheral artery disease, value-based medicine, cost-effectiveness, and payment model. Contemporary guidelines, randomized or prospective comparative studies, cost-effectiveness analyses, and national policy documents were included; editorials, small case series, and non-English papers were excluded. Relevant gray literature (eg, Centers for Medicare and Medicaid Services payment-model frameworks, American College of Surgeons/Society for Vascular Surgery Vascular Verification Program manual) was also consulted. For intermittent claudication, primary objectives include decreasing cardiovascular morbidity and mortality, improving functional performance and quality of life via supervised exercise therapy, lifestyle modification, and optimal pharmacological management. Advanced imaging modalities, such as duplex ultrasound examination, computed tomography angiography, and magnetic resonance angiography, are cost effective primarily for preprocedural planning. Conversely, simple and accessible tests, like the ankle-brachial index and toe pressures with pulse volume recordings, offer cost-effective initial screening and surveillance. Optimal timing of interventions balances preventing progression to chronic limb-threatening ischemia with avoiding unnecessary and costly early interventions. Recent landmark trials inform decision-making around surgical and endovascular interventions, emphasizing patient-specific strategies that balance clinical outcomes and costs. Effective PAD management requires transitioning from volume-driven care to value-based paradigms, emphasizing evidence-based preventive measures, appropriate diagnostic tools, judicious timing of interventions, and multidisciplinary teamwork. Adopting VBM principles promises improved patient outcomes, cost efficiency, and sustainable care delivery in PAD populations.