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Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review

Published online by Cambridge University Press:  01 April 2007

Yvonne C. Jonk ,
Robert L. Kane ,
Frank A. Lederle ,
Roderick MacDonald ,
Andrea H. Cutting  and
Timothy J. Wilt
Yvonne C. Jonk
Affiliation:
University of Minnesota and Minneapolis VA Center for Chronic Disease Outcomes Research
Robert L. Kane
Affiliation:
University of Minnesota
Frank A. Lederle
Affiliation:
University of Minnesota and Minneapolis VA Center for Chronic Disease Outcomes Research
Roderick MacDonald
Affiliation:
Minneapolis VA Center for Chronic Disease Outcomes Research
Andrea H. Cutting
Affiliation:
Minneapolis VA Center for Chronic Disease Outcomes Research
Timothy J. Wilt
Affiliation:
University of Minnesota and Minneapolis VA Center for Chronic Disease Outcomes Research
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Abstract

Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options.

Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded.

Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival.

Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.

Keywords

Aortic aneurysmAbdominalCost-effectivenessSystematic reviewBlood vessel prosthesisSurgical proceduresOperative
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 205 - 215
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Angle, N, Dorafshar, AH, Moore, WS et al. , Open versus endovascular repair of abdominal aortic aneurysms: What does each really cost? Ann Vasc Surg. 2004; 18: 612–618.CrossRefGoogle ScholarPubMed
2.Anonymous; for the UK Small Aneurysm Trial Participants. Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet. 1998; 352: 1656–1660.CrossRefGoogle Scholar
3.Berman, SS, Gentile, AT, Berens, ES et al. , Institutional economic losses associated with AAA repair are independent of technique. J Endovasc Ther. 2002; 9: 282–288.CrossRefGoogle ScholarPubMed
4.Bertges, DJ, Zwolak, RM, Deaton, DH et al. , Current hospital costs and Medicare reimbursement for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003; 37: 272–279.CrossRefGoogle ScholarPubMed
5.Bosch, JL, Kaufman, JA, Beinfeld, MT et al. , Abdominal aortic aneurysms: Cost-effectiveness of elective endovascular and open surgical repair. Radiology. 2002; 225: 337–344.CrossRefGoogle ScholarPubMed
6.Bosch, JL, Lester, JS, McMahon, PM et al. , Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms. Radiology. 2001; 220: 492–497.CrossRefGoogle ScholarPubMed
7.Brewster, DC, Geller, SC, Kaufman, JA et al. , Initial experience with endovascular aneurysm repair: Comparison of early results with outcome of conventional open repair. J Vasc Surg. 1998; 27: 992–1005.CrossRefGoogle ScholarPubMed
8.Brox, AC, Filion, KB, Zhang, X et al. , In-hospital cost of abdominal aortic aneurysm repair in Canada and the United States. Arch Intern Med. 2003; 163: 2500–2504.CrossRefGoogle ScholarPubMed
9.Bush, RL, Najibi, S, Lin, PH et al. , Conservatism and new technology: The impact on abdominal aortic aneurysm repair. Am Surg. 2002; 68: 57–60.CrossRefGoogle ScholarPubMed
10.Clair, DG, Gray, B, O'Hara, P J, Ouriel, K. An evaluation of the costs to health care institutions of endovascular aortic aneurysm repair. J Vasc Surg. 2000; 32: 148–152.CrossRefGoogle ScholarPubMed
11.Dorffner, R, Thurnher, S, Polterauer, P, Kretschmer, G, Lammer, J. Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: Complications and secondary radiologic intervention. Radiology. 1997; 204: 79–86.CrossRefGoogle ScholarPubMed
12.Drummond, MF, Sculpher, M. Common methodological flaws in economic evaluations. Med Care. 2005; 43 (Suppl): 5–14.CrossRefGoogle ScholarPubMed
13.Dryjski, M, O'Brien-Irr, MS, Hassett, J. Hospital costs for endovascular and open repair of abdominal aortic aneurysm. J Am Coll Surg. 2003; 197: 64–70.CrossRefGoogle ScholarPubMed
14.EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): Randomised controlled trial. Lancet. 2005; 365: 2179–2186.CrossRefGoogle Scholar
15.EVAR, trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): Randomised controlled trial. Lancet. 2005; 365: 2187–2192.Google Scholar
16.Gillum, RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. 1995; 48: 1289–1298.CrossRefGoogle ScholarPubMed
17.Gold, MRSiegel, JERussell, LBWeinstein, MC, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.CrossRefGoogle ScholarPubMed
18.Hayter, CL, Bradshaw, SR, Allen, RJ, Guduguntla, M, Hardman, DT. Follow-up costs increase the cost disparity between endovascular and open abdominal aortic aneurysm repair. J Vasc Surg. 2005; 42: 912–918.CrossRefGoogle ScholarPubMed
19.Hirsch, AT, Haskal, ZJ, Hertzer, NR et al. , ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): Executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006; 47: 1239–1312.CrossRefGoogle Scholar
20.Huber, TS, Wang, JG, Derrow, AE et al. , Experience in the United States with intact abdominal aortic aneurysm repair. J Vasc Surg. 2001; 33: 304–310.CrossRefGoogle ScholarPubMed
21.Lawrence, PF, Gazak, C, Bhirangi, L et al. , The epidemiology of surgically repaired aneurysms in the United States. J Vasc Surg. 1999; 30: 632–640.CrossRefGoogle ScholarPubMed
22.Lederle, FA, Johnson, GR, Wilson, SE et al. , Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002; 287: 2968–2972.CrossRefGoogle ScholarPubMed
23.Lee, WA, Carter, JW, Upchurch, G, Seeger, JM, Huber, TS. Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001. J Vasc Surg. 2004; 39: 491–496.CrossRefGoogle ScholarPubMed
24.Lester, JS, Bosch, JL, Kaufman, JA, Halpern, EF, Gazelle, GS. Inpatient costs of routine endovascular repair of abdominal aortic aneurysm. Acad Radiol. 2001; 8: 639–646.CrossRefGoogle ScholarPubMed
25.Lucas, FL, Stukel, TA, Morris, AM, Siewers, AE, Birkmeyer, JD. Race and surgical mortality in the United States. Ann Surg. 2006; 243: 281–286.CrossRefGoogle ScholarPubMed
26.Maher, MM, McNamara, AM, MacEneaney, PM, Sheehan, SJ, Malone, DE. Abdominal aortic aneurysms: Elective endovascular repair versus conventional surgery–evaluation with evidence-based medicine techniques. Radiology. 2003; 228: 647–658.CrossRefGoogle ScholarPubMed
27.Meenan, RT, Fleming, C, Whitlock, EP, Beil, TL, Smith, P. 2005. Cost-effectiveness analyses of population-based screening for abdominal aortic aneurysm. Agency for Healthcare Research and Quality, Rockville, MD. 2005 Feb. Available at: http://www.ahrq.gov/clinic/uspstf05/aaascr/aaacost.htm. Accessed DecemberGoogle Scholar
28.Michaels, JA, Drury, D, Thomas, SM. Cost-effectiveness of endovascular abdominal aortic aneurysm repair. Br J Surg. 2005; 92: 960–967.CrossRefGoogle ScholarPubMed
29.Patel, ST, Haser, PB, Bush, HL Jr, Kent, KC. The cost-effectiveness of endovascular repair versus open surgical repair of abdominal aortic aneurysms: A decision analysis model. J Vasc Surg. 1999; 29: 958–972.CrossRefGoogle ScholarPubMed
30.Prinssen, M, Wixon, CL, Buskens, E et al. , Surveillance after endovascular aneurysm repair: Diagnostics, complications, and associated costs. Ann Vasc Surg. 2004; 18: 421–427.CrossRefGoogle ScholarPubMed
31.Reed, SD, Anstrom, KJ, Bakhai, A et al. , Conducting economic evaluations alongside multinational clinical trials: Toward a research consensus. Am Heart J. 2005; 149: 434–443.CrossRefGoogle Scholar
32.Schermerhorn, ML, Birkmeyer, JD, Gould, DA, Cronenwett, JL. Cost-effectiveness of surgery for small abdominal aortic aneurysms on the basis of data from the United Kingdom small aneurysm trial. J Vasc Surg. 2000; 31: 217–226.CrossRefGoogle ScholarPubMed
33.Sternbergh, WC III, Money, SR. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: A multicenter study. J Vasc Surg. 2000; 31: 237–244.CrossRefGoogle ScholarPubMed
34.Treiman, GS, Lawrence, PF, Edwards, WH Jr et al. , An assessment of the current applicability of the EVT endovascular graft for treatment of patients with an infrarenal abdominal aortic aneurysm. J Vasc Surg. 1999; 30: 68–75.CrossRefGoogle ScholarPubMed
35.Weinstein, MC, Siegel, JE, Gold, MR, Kamlet, MS, Russell, LB. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA. 1996; 276: 1253–1258.CrossRefGoogle ScholarPubMed
36.Wilt, TJ, Lederle, FA, MacDonald, R et al. , Comparison of endovascular and open surgical repairs for abdominal aortic aneurysm. Evidence Report/Technology Assessment No. 144 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 06-E017. Rockville, MD: Agency for Healthcare Research and Quality; August 2006.Google Scholar
37.Zierler, BK, Gray, DT. The principles of cost-effectiveness analysis and their application. J Vasc Surg. 2003; 37: 226–234.CrossRefGoogle ScholarPubMed