The Balance of Open vs Endovascular Aneurysm Repair

Abstract

This issue of JAMA Surgery reports a follow-up to 9 years of the Open vs Endovascular Repair (OVER) trial population, 1 including 881 patients from 42 Veterans Affairs medical centers, in which Lederle and colleagues 2 analyze the management of abdominal aortic aneurysm (AAA) repair based on cost. Whether examining mean life-years or qualityadjusted life-years (QALYs), the authors documented cost equipoise between the open and endovascular repair groups. An examination of total health care costs also did not differ significantly between the 2 groups ($142 745 for endovascular vs $153 533 for open repairs; P = .25). When specific costs were examined in detail, the initial cost of the procedures constituted nearly 40% of the total cost and did not differ by repair type. Finally, using bootstrap analysis, the authors documented the probability that endovascular repair was less costly and more effective was 56.8% when measured in mean lifeyears and 55.4% when measured in QALYs.In their Discussion, the authors pointed out that a recent cost-effectiveness analysis 3 based on 4 randomized trials (3 European trials and the OVER trial as the only one performed in the United States) concluded that longer hospital stays were associated with open repair. However, this finding was not sufficient to offset the endograft price, which typically is the largest priced item associated with endovascular repair. This appears to be especially true in the United States, where endograft costs have never followed the law of supply and demand. We now have at least 6 US Food and Drug Administration-