Abdominal aortic aneurysms: cost-effectiveness of elective endovascular and open surgical repair.
OBJECTIVE
To evaluate the cost-effectiveness of elective endovascular and open surgical repair of infrarenal abdominal aortic aneurysms (AAAs) by taking into account short- and long-term outcomes.


METHODS
A Markov decision model was developed to evaluate quality-adjusted life-years (QALYs) and lifetime costs of endovascular and open surgical repair. The incremental cost-effectiveness ratio (CER) was calculated for endovascular repair relative to open surgery in a cohort of 70-year-old men with an AAA between 5 and 6 cm in diameter. Clinically effectiveness data were derived from the literature. Cost data were derived from Medicare reimbursement rates, the hospital database, and the literature. One- and multiple-way sensitivity analyses were performed on uncertain model parameters. Costs were converted to year 2000 U.S. dollars; future costs and outcomes were discounted at 3%.


RESULTS
The incremental CER of endovascular repair was 9,905 dollars per QALY. QALYs and lifetime costs were higher for endovascular repair than for open surgery (6.74 vs 6.52 and 39,785 dollars vs 37,606 dollars, respectively). In sensitivity analyses, the incremental CER was insensitive to immediate conversion rate and procedure mortality rate. The incremental CER was sensitive (ie, more than 75,000 dollars per QALY or endovascular repair was ruled out by dominance) to systemic-remote complications, long-term failures, and ruptures.


CONCLUSIONS
The results suggest that endovascular repair is a cost-effective alternative compared with open surgery for the elective repair of AAA. The benefits and cost-effectiveness are highly dependent on uncertain outcomes, however, particularly long-term failure and rupture rates.
Bosch
Johanna L
JL
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Suite 2H, Boston, MA 02114, USA. johanna@the-data-group.org
Kaufman
John A
JA
Beinfeld
Molly T
MT
Adriaensen
Miraude E A P M
ME
Brewster
David C
DC
Gazelle
G Scott
GS
D000368:Aged; D000800:Angioplasty, Balloon / Q000191:economics*; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000191:economics / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008390:Markov Chains; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000601:surgery; D019057:Quality-Adjusted Life Years; D012086:Reoperation / Q000191:economics / Q000401:mortality; D016019:Survival Analysis; D014481:United States