Modelling the long-term cost-effectiveness of endovascular or open repair for abdominal aortic aneurysm

Epstein, David; Sculpher, Mark; Manca, Andrea; Michaels, Jonathan; Thompson, Simon G.; Brown, L.C.; Powell, J.T.; Buxton, Martin; Greenhalgh, Roger M.

doi:10.1002/bjs.5911

Cited by 53 publications

(72 citation statements)

References 17 publications

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“…However, the short time horizon in the analysis may be biased, as it assumes no difference in survival (or costs) beyond 1 year. The EVAR model (2008) 200 was a lifetime analysis extrapolating from the 4-year results of EVAR trial 1. This study concluded that EVAR was unlikely to be cost-effective, given the assumptions that patients faced a continuing elevated risk (compared with open repair) of late AAA mortality and reinterventions after EVAR for the rest of their lives and that there was no difference in overall survival after 4 years.…”

Section: 208mentioning

confidence: 99%

“…There have been a number of recent published economic evaluations of these treatments. This chapter reviews the methods and data used in those studies, highlights the key uncertainties about the cost-effectiveness of the treatments, and updates a previously published decision model 200 in the light of the recently available mid-and long-term results of the relevant clinical trials: the EVAR trial 1, 201 the DREAM 160 and the OVER trials. 165 …”

Section: Introductionmentioning

confidence: 99%

“…were included in some earlier modelling studies. 200,208 They are not included in the current model as no significant evidence of any difference was apparent (see Chapter 4, Adverse events and Chapter 4, Cardiovascular mortality and events).…”

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confidence: 99%

“…Univariate sensitivity analyses Table 44 shows the mean values of the parameters in the base case and in three alternative scenarios: a scenario using the inputs estimated in EVAR 2008, 200 a scenario based on the NICE FAD 208 and a scenario based on the results for in-hospital mortality, overall survival and reinterventions of the OVER trial. 165 To identify which parameters had the most influence on the model results, the values in the base-case model were varied one at a time to correspond with these alternative scenarios in a series of univariate sensitivity analyses.…”

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confidence: 99%

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The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Brown

Powell²,

Thompson³

et al. 2012

Health Technol Assess

206

170

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

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Section: 208mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Brown

Powell²,

Thompson³

et al. 2012

Health Technol Assess

206

170

View full text Add to dashboard Cite

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“…In their model, conversion from OSR to EVAR was not included as it is unlikely and the EVAR 1 trial showed that none of the OSR patients were converted. 45 Furthermore, mortality (all-cause and aneurysm related) and complications during the first 30 days need to be incorporated in the short-term model, if a difference between interventions exists. Complications can be categorised into four types: cardiac complications [e.g.…”

Section: Short-term Model (Fit For Open Surgical Repair)mentioning

confidence: 99%

The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: a systematic review and cost-effectiveness analysis

Armstrong

Burgers

Deshpande

et al. 2014

Health Technology Assessment

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BackgroundPatients with large abdominal aortic aneurysms (AAAs) are usually offered reparative treatment given the high mortality risk. There is uncertainty about how to treat juxtarenal AAAs (JRAAAs) or thoracoabdominal aortic aneurysms (TAAAs). Endovascular repair of an abdominal aortic aneurysm (EVAR) is often seen as safer and easier than open surgical repair (OSR). However, endovascular treatment of JRAAAs or TAAAs requires specially manufactured stent grafts, with openings to allow blood to reach branches of the aorta. Commissioners are receiving increasing requests for fenestrated EVAR (fEVAR) and branched EVAR (bEVAR), but it is unclear whether or not the extra cost of fEVAR or bEVAR is justified by advantages for patients.Objective(s)To assess the clinical effectiveness, safety and cost-effectiveness of fEVAR and bEVAR in comparison with conventional treatment (i.e. no surgery) or OSR for two populations: JRAAAs and TAAAs.Data sourcesResources were searched from inception to October 2013, including MEDLINE (OvidSP), EMBASE (OvidSP) and the Cochrane Central Register of Controlled Trials (Wiley) and, additionally, for cost-effectiveness, NHS Economic Evaluation Database (NHS EED; Wiley) and EconLit (EBSCOhost). Conference abstracts were also searched.Review methodsStudies were included based on an intervention of either fEVAR or bEVAR and a comparator of either OSR or no surgery. For clinical effectiveness, observational studies were excluded only if they were not comparative, i.e. explicitly selected on the basis of prognosis.ResultsFor clinical effectiveness, searches retrieved 5253 records before deduplication. Owing to overlap between the databases, 1985 duplicate records were removed. Of the remaining 3268 records, based on titles and abstracts, 3244 records were excluded, leaving 24 publications to be ordered. All 24 studies were excluded as none of them satisfied the inclusion criteria. Sixteen studies were excluded on study design, six on intervention and two on comparator. Five out of 16 studies excluded on study design reported a comparison. However, all of the studies acknowledged that they had groups that were not comparable at baseline given that they had selectively assigned younger, fitter patients to OSR. Therefore, these studies were considered ‘non-comparative’. For cost-effectiveness, searches identified 104 references before deduplication. Owing to overlap between the databases, 34 duplicate records were removed. Of the remaining 70 records, seven were included for the full assessment based on initial screening. After a full-text review, no studies were included. Because of the lack of clinical effectiveness evidence and difficulty in estimating costs given the rapidly changing and variable technology, a cost-effectiveness analysis (CEA) was not performed. Instead a detailed description of modelling methods was provided.ConclusionsDespite a thorough search, no studies could be found that met the inclusion criteria. All studies that compared either fEVAR or bEVAR with either OSR or no surgery explicitly selected patients based on prognosis, i.e. essentially the populations for each comparator were not the same. Despite not being able to conduct a CEA, we have provided detailed methods for the conduct if data becomes available.Future workWe recommend at least one clinical trial to provide an unbiased estimate of effect for fEVAR/bEVAR compared with OSR or no surgery. This trial should also collect data for a CEA.Study registrationThis study is registered as PROSPERO CRD42013006051.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Strength of public preferences for endovascular or open aortic aneurysm repair

Wickramasekera

Howard

Philips

et al. 2019

British Journal of Surgery

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Background This study evaluated public preferences for the treatment processes for abdominal aortic aneurysm repair in order to allow them to be incorporated into a cost‐effectiveness analysis. Methods This was a telephone survey using a trade‐off method in UK resident adults (aged at least 18 years) with no previous diagnosis of a vascular condition. Results Some 167 of 209 participants (79·9 per cent) stated that they would prefer endovascular aneurysm repair (EVAR), 40 (19·1 per cent) preferred open surgery and two (1·0 per cent) stated no preference. Participants preferred EVAR because of the less invasive nature of the intervention and quicker recovery. Participants preferring open surgery cited reasons such as having a single follow‐up appointment, and a procedure that felt more permanent. When participants were asked to make a sacrifice in order to have their preferred treatment, 122 (58·4 per cent) favoured EVAR, 18 (8·6 per cent) favoured open surgery and 69 (33·0 per cent) had no preference. Those preferring EVAR were willing to give up a mean of 0·135 expected quality‐adjusted life‐years (QALYs) to have EVAR, compared with a willingness to give up 0·033 expected QALYs among those preferring open repair. Conclusion These results indicate a clear preference for EVAR over open surgery for aortic aneurysm.

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Modelling the long-term cost-effectiveness of endovascular or open repair for abdominal aortic aneurysm

Abstract: EVAR is unlikely to be cost-effective on the basis of existing devices, costs and evidence, but there remains considerable uncertainty.

Cited by 53 publications

References 17 publications

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: a systematic review and cost-effectiveness analysis

Strength of public preferences for endovascular or open aortic aneurysm repair

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