Mid‐term cost‐effectiveness analysis of open and endovascular repair for ruptured abdominal aortic aneurysm. Issue 3 (February 2014)

• Record Type: Journal Article
• Authors: Rollins, K. E.; Shak, J.; Ambler, G. K.; Tang, T. Y.; Hayes, P. D.; Boyle, J. R.
• Is Part Of: British journal of surgery. Volume 101:Issue 3(2014:Mar.)
• Page Start: 225
• Page End: 231
• Publication Date: 2014-02
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9409
• Languages: English
• ISSNs: 0007-1323

Abstract

<abstract abstract-type="main" id="bjs9409-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjs9409-sec-0001" sec-type="section"> <title>Background</title> <p id="bjs9409-para-0001"> <bold>Emergency endovascular repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) may have lower operative mortality rates than open surgical repair. Concerns remain that the early survival benefit after EVAR for rAAA may be offset by late reinterventions. The aim of this study was to compare reintervention rates and cost‐effectiveness of EVAR and open repair for rAAA.</bold> </p> </sec> <sec id="bjs9409-sec-0002" sec-type="section"> <title>Methods</title> <p id="bjs9409-para-0002"> <bold>A retrospective analysis was undertaken of patients with rAAA undergoing EVAR or open repair over 6 years. A health economic model developed for the cost‐effectiveness of elective EVAR was used in the emergency setting.</bold> </p> </sec> <sec id="bjs9409-sec-0003" sec-type="section"> <title>Results</title> <p id="bjs9409-para-0003"> <bold>Sixty‐two patients (mean age 77·9 years) underwent EVAR and 85 (mean age 75·9 years) had open repair of rAAA. Median follow‐up was 42 and 39 months respectively. There was no significant difference in 30‐day mortality rates after EVAR and open repair (18 and 26 per cent respectively; <italic>P =</italic> 0·243). Reintervention rates were also similar (32 and 31 per cent; <italic>P =</italic> 0·701). The mean cost per patient was €26 725 for EVAR and €30 297 for open repair, and the cost per life‐year gained was €7906 and €9933 respectively (<italic>P =</italic> 0·561). Open repair had greater initial costs: longer procedural times (217 <italic>versus</italic> 178·5 min; <italic>P</italic> < 0·001) and intensive care stay (5·0 <italic>versus</italic> 1·0 days; <italic>P =</italic> 0·015). Conversely, EVAR had greater reintervention (€156 939 <italic>versus</italic> €35 335; <italic>P =</italic> 0·001) and surveillance (<italic>P</italic> < 0·001) costs.</bold> </p> </sec> <sec id="bjs9409-sec-0004" sec-type="section"> <title>Conclusion</title> <p id="bjs9409-para-0004"> <bold>There was no significant difference in reintervention rates after EVAR or open repair for rAAA. EVAR was as cost‐effective at mid‐term follow‐up. The increased procedural costs of open repair are not outweighed by greater surveillance and reintervention costs after EVAR.</bold> </p> </sec> </abstract>