RAPHAEL ADAR and NAVA PLISKIN COST ANALYSIS OF THE UTILIZATION OF NEW VASCULAR GRAFTS* ABSTRACT. A cost analysis of the utilization of new expensive vascular grafts is performed, applying the methodology of decision analysis to the theoretical case of a sixty year old male patient undergoing femoropoplitealgrafting for limb threatening ischemla. The problem is presented graphically as a decision tree, uncertainties are quantified in terms of probabili- ties and end outcomes are evaluated in monetary terms. This information is then utilized to calculate cost values associated with alternative actions. Based on initial cumulative patency figures of the new more expensive grafts and the known performance of the older grafts, the initial high expense for the new grafts is justified economically, if the saphenous vein is not available. This analysis, apart from giving an answer to a specific clinical problem, can be viewed as a general model for cost analysis of surgical procedures. Key words: Decision analysis, Cost analysis, Vascular surgery, Vascular grafting, Femoropop- liteal grafting. 0. INTRODUCTION Many medical decisions, especially those involving surgical practices that are relatively expensive, are now increasingly being scrutinized using the yardstick of cost containment. The more limited the resources of the society are, the more weight is likely to be carried by economic considerations. Even though this may be distasteful to the medical community,there is some merit in the point of view that "strengthening price consciousness ... will lead in terms of cost, quality and access, to an optimal program of health care delivery" [8]. A common situation in surgery is the widespread adoption of new, often expensive procedures or devices, before their real advantage over older practices has been conclusively proven. When these new procedures are attractive on medical grounds, a conflict may arise if limited resources prevent their wide- spread application. Just as the medical merits of such new procedures have to be critically evaluated by appropriately controlled clinical trials, so too the economic implications have to be analyzed. This may be done using quantitative tools [2, 4, 23, 24] and the results of such a scrutiny are not necessarily detrimental to the adoption of new surgical practices. The present report deals with the cost analysis of the utilization of new vascular grafts in the revascularization of the ischemic lower extremity. The golden standard for grafting in this situation is the performance of the auto- geneous saphenous vein. The most common substitute, until recently, has been the dacron graft, at a cost of about $60 per graft. During the past 3-4 years Metamedicine 1 (1980)213-223. 0166-2031/80/0012-0213 $01.10 Copyright 9 1980 by D. Reidel Publishing Company.