Cost-effectiveness analysis of endovascular versus open repair of abdominal aortic aneurysm in a high-volume center

NICE Guidelines for AAA Repair: An Enigma

“…These recommendations are open to interpretation. We have to hope that those doing the deciphering 4 do so ethically and objectively.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…And the risk factor most associated with 30-day readmission after elective AAA repair was surgical site infection [227] and cardiac complications (138,014 pts, United States Nationwide Readmission Database from 2010 to 2014) [228]. Despite these events, EVAR is cost-effective with improved cost per Quality Adjusted Life Years (QALY) compared with open surgical repair [229]. And long-term overall survival rates were similar for EVAR and open repair over 10 years in a meta-analysis of 53 studies [230] which was confirmed in a retrospective, population-based cohort study used linked administrative health data from Ontario, Canada, of 17,683 elective EVARs [231].…”

Re: Proposed NICE Abdominal Aortic Aneurysm Repair Guidelines: Swinging the Pendulum too Far?

“…Our group has reported previously that thorough preoperative assessment of vein status in every patient is crucial for success of the operation. 2,3 We check the diameter of the vein and, if there is suspicion of varicose veins, we do check for valve dysfunction in the same assessment. We did not observe expansion of the vein graft either before or after the operation in any of these patients.…”

“…More recent non-randomised data confirm the long term cost effectiveness of EVAR. 3,4 However, we acknowledge that caution must be exercised when transferring the results of economic evaluations from one country to another.…”

“…The long term survival benefit of endovascular aneurysm repair (EVAR) vs. open surgical repair (OSR) has not been challenged but rather disproved by multiple randomised controlled trials and this should not be used in an argument for EVAR. 2,3 In terms of cost analysis, the authors use the OVER trial, which showed no cost difference between the two modalities after two years as evidence for EVAR. 4 However it can be argued with the same data that with the cost of ongoing surveillance and intervention, EVAR would not be as cost effective as OSR in the long term and I do not think the vascular community should be using cost effectiveness as an argument for EVAR.…”