Cost-effectiveness analysis of elective endovascular repair compared with open surgical repair of abdominal aortic aneurysms for patients at a high surgical risk: A 1-year patient-level analysis conducted in Ontario, Canada

Abstract

According to this 1-year observational study, EVAR may be a cost-effective strategy compared with OSR for high-risk patients. Longer-term data are needed to decrease the uncertainty associated with the results.

Regarding “Cost-effectiveness analysis of elective endovascular repair compared with open surgical repair of abdominal aortic aneurysms for patients at a high surgical risk: A 1-year patient-level analysis conducted in Ontario, Canada”

“…Our conclusion also stated that "longer term data are needed to decrease the uncertainty associated with the results". 1 We agree with Dr Paraskevas that it is very important to model the long-term costs and consequences associated with EVAR and OSR. We recognize, as outlined in the discussion, that our extrapolations to a 5-year time horizon did not fully take into account the development and management of long-term comorbidities and differences in quality of life.…”

“…Based on bootstrap techniques to deal with sampling uncertainty, the probability of EVAR being cost-effective was 0.76 and 0.9 if society was willing to spend $50,000 per life year gained (LYG) or $100,000/ LYG, respectively. 1 In a sensitivity analysis, we extrapolated the 1-year mortality rate observed in our trial to a 5-year time horizon. We assumed long-term routine follow-up costs to EVAR only and several re-intervention rates (5%, 10%, and 20%) in EVAR patients to reflect an increased risk of long-term complications following EVAR.…”

Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenarians

“…Thus, cost-effectiveness estimates largely depend on the quality of life gained by the patient, data that were not obtained in this study. 20 In one recent report, compared with open repair, patients aged Ն80 who underwent EVAR had a statistically significant more rapid return to baseline despite a lower quality of life at 6 months. 21 Preoperative and anticipated postoperative quality of life are essential in the consideration of which nonagenarians to intervene on.…”

Trends in management of abdominal aortic aneurysms

“…It was not until approximately 5 years ago that a more stable funding base permitted more widespread adoption. 7 According to administrative databases, approximately 40% of nonurgent aneurysms are currently being treated with endovascular stent grafts in Ontario.…”

“…In our province of Ontario, it was not until a health technology assessment led to dedicated EVAR funding, after determining cost equivalence in high-risk patients, did more widespread dissemination of this technology occur. 7 Additionally, as opposed to many areas in the United States, vascular surgery services in Canada, specifically aneurysm surgery, are increasingly centralized at fewer, but higher-volume centers. 8 Our university-affiliated institution provides vascular surgery care to approximately 1.9 million people and is the only center in southwestern Ontario to offer endovascular repair of aortic aneurysms.…”