Similar Cost for Elective Open and Endovascular AAA Repair in a Population-Based Setting

Abstract

In a population-based setting, total cost was similar for OR and EVAR. There were, however, important differences in patient characteristics and cost structure.

Challenges in analysis and interpretation of cost data in vascular surgery

“…One presented median cost data, 12 and 10 presented mean cost data. 8,11,[13][14][15][16][17][18][19][20] Skewedness of cost data and its effect on statistical analysis was discussed in three reports, 8,14,15 and A nonparametric significance test for assessing whether two independent samples of observations come from the same distribution. The Mann-Whitney U test is based on ranking of data and does not assume normal distribution of data.…”

“…17,18 Three studies discussed the cost of specific subgroups, such as patients with complications vs patients without complications, and their effect on total cost, 11,17,20 but only one study specifically discussed the effect of outlier values on the results. 18 Distribution of cost data was visualized with histograms in two reports 8,15 and with cost-effect plots in two reports. 11,14 A variety of methods were used for inferential statistics (Table II).…”

Cost-effectiveness of intensive smoking cessation therapy among patients with small abdominal aortic aneurysms

“…Although this assumption was not part of the Markov model per se, the perioperative mortality data and cost data used in the model were from the Swedvasc Registry and a population-based study where the rate of EVAR was approximately 50%. 25,29 The increasing rate of EVAR could affect perioperative mortality rates after intact and ruptured AAA repair as well as the cost of AAA repair and follow-up. As shown in the sensitivity analysis in Table IV, the intervention strategy was cost-effective regardless of variations in perioperative mortality, rupture mortality, cost of AAA repair, and cost of follow-up after AAA repair.…”

“…Overall mortality after AAA rupture was estimated at 79%, based on studies performed during a period when open repair was performed for ruptured AAA. 1,16,17,27,28 Cost of AAA repair, including cost of postoperative follow-up, was established using data from our institution 29 and a literature review 30,31 and was estimated to be the same in smokers and former smokers in the base case. The cost of repair was derived from mixed use of open surgical and endovascular repair of AAAs in a populationbased setting, 29 assuming that approximately half of the patients would undergo open repair and half EVAR for intact AAA.…”

“…The postoperative cost included the cost of all clinical follow-up, imaging, reoperations, and reinterventions. 29 The long-term mortality rate was calculated from a previous analysis of long-term survival among AAA patients in the Swedvasc registry (standardized mortality ratio of 1.4 for AAA patients compared with a healthy population adjusted for age, sex, and calendar year). 26 This value was adjusted for the difference in survival between current and previous smokers, with an adjusted hazard ratio of death of 1.25 for current smokers with AAA compared with former smokers with AAA.…”