Cost-Benefit Analysis of Endovascular Versus Open Abdominal Aortic Aneurysm Treatment

Follow-up costs increase the cost disparity between endovascular and open abdominal aortic aneurysm repair

“…It is clear that graft cost remains the largest determinant of overall hospital costs for EVAR. Initial studies in the late 1990s reported that EVAR was less costly 4,5 or equal in cost 6,7 to OR. Those studies, however, had small sample sizes and relatively low graft costs because they were conducted within the context of clinical trials, and grafts were provided to investigators at significantly reduced prices.…”

“…Early studies reported that EVAR was less costly 4,5 or equivalent 6,7 in cost to OR because of reduced lengths of hospital stay and fewer intensive care unit (ICU) admissions. These studies, however, were performed within the context of clinical trials, and the costs of the endografts were significantly less than in the current commercial environment.…”

The principles of cost-effectiveness analysis and their application

“…Complications relevant to AAA repair could include all-cause mortality, myocardial infarction, pulmonary complications, limb ischemia requiring major amputation, renal failure, graft infection, wound dehiscence, continued AAA sac growth, rupture, and stroke. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] It is important to note the duration of follow-up and the cost components included (eg, inclusion of inpatient and outpatient facility and physician care costs, nursing home costs, costs of lost productivity). Studies also need to identify specific outcomes (eg, one or more key primary outcomes or a composite such as 2-year survival free of rupture or of repeat intervention) for use in calculating cost-effectiveness ratios (described subsequently).…”

“…11 A literature search identified 14 English-language articles that compared costs and outcomes of OSR and EVR of AAAs. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] An informal review indicated substantial room for improvement in adherence to principles of economic analysis. For example, claims made in a number of articles about the cost effectiveness or cost benefit of one strategy or the other were not well supported by the accompanying data.…”

“…Our intent is not to actually conduct such an analysis with existing data but to describe the principles for conducting or reviewing an economic analysis with realistic data. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] The controversy about treatment of AAAs less than 5 cm or between 5 cm and 6 cm is beyond the scope of this discussion. For the purpose of this paper and as an academic exercise only, we have arbitrarily chosen 5 cm as the threshold for intervention in comparing OSR with EVR.…”