title: An evaluation of the costs to health care institutions of endovascular aortic aneurysm repair.
abstract: BACKGROUND
  Endovascular graft techniques hold great potential as a less invasive means for the repair of aortic aneurysms, yet the impact of these new modalities remains poorly elucidated.
  
  
  METHODS
  Over a 10-month period at a single institution, 139 patients underwent infrarenal aortic aneurysm repair through a traditional open surgical technique (OS group, 94 patients) or an endovascular approach (ES group, 45 patients). Coated polyester prostheses (Hemashield; Boston Scientific Corporation, Boston, Mass) were used in the OS patients, whereas a modular nitinol polyester device (AneuRx; Medtronic, Sunnyvale, Calif) was used in the ES group. The hospital costs exclusive of professional charges were tabulated for the two groups using the hospital cost accounting system. Outliers were included in the data analysis.
  
  
  RESULTS
  The mean operating room time was longer in the OS group than in the ES group (285 minutes vs 166 minutes). The average length of stay was also longer in the OS group (9.7 days vs 3.2 days). Hospital costs related to the length of stay were higher in the OS group, including laboratory costs ($327 higher), pharmacy costs ($688 higher), and nursing costs ($780 higher). Anesthesia costs were also higher in the OS group ($493 higher). Despite these marked differences, the total hospital cost averaged $7205 more in the ES group, a finding that was driven by the cost of the implantable devices themselves ($8976 in the ES group vs $597 in the OS group).
  
  
  CONCLUSIONS
  Despite reductions in the length of hospitalization, the cost of care was substantially greater in patients undergoing endovascular aneurysm repair than in patients in whom an open surgical technique was used. These differences are driven by the cost of the endograft device itself, a cost that must not exceed $6000 if the economic impact of endovascular repair is to be in parity with traditional methods. Unless these economic disparities can be ameliorated, the economic impact of endovascular aneurysm repair may limit the widespread application of this technology.
authors.affiliation: Departments of Vascular Surgery and Vascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Clair
authors.forename: B
authors.initials: B
authors.lastname: Gray
authors.forename: P J
authors.initials: PJ
authors.lastname: O'hara
authors.forename: K
authors.initials: K
authors.lastname: Ouriel
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics*; D005069:Evaluation Studies as Topic; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D009820:Ohio; D016896:Treatment Outcome