title: A cost-effectiveness analysis of standard versus endovascular abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  To compare endovascular and standard open repair of abdominal aortic aneurysms in terms of initial in-hospital costs and the costs of secondary interventions and surveillance.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  A university-affiliated tertiary care medical centre.
  
  
  METHODS
  Seven patients who underwent elective endovascular (EV) repair of an abdominal aortic aneurysm in 1998 and 31 patients anatomically suitable for endovascular repair who underwent standard (STAN) elective repair. Follow-up ranged from 2 to 14 months.
  
  
  METHODS
  Elective repair of an abdominal aortic aneurysm with use of the standard technique or endovascular technology.
  
  
  METHODS
  Costs common to both groups were not determined. Costs were determined for total hospital stay, preoperative or postoperative embolization, grafts, additional endovascular equipment, and follow-up computed tomography.
  
  
  RESULTS
  Groups were similar with respect to demographic data and aneurysm size (EV = 6.23 cm v. STAN = 6.05 cm). All patients were in American Society of Anesthesiologists class III or IV. Vanguar bifurcated grafts and extensions were used in the EV group. The total cost for both groups in Canadian dollars included: cost of stay (EV, 5.6 d, $2092.63 v. STAN, 10.7 d, $4449.19; p = 0.009); cost of embolization (EV, n = 3; $900/procedure); cost of follow-up CT (EV, 5.4 per patient; $450/CT); cost of grafts (EV = $8571.43, STAN = $374); additional radiologic equipment costs (EV = $1475). The mean total cost differed significantly between the 2 groups (EV = $14,967.63 v. STAN = $4823.19; p = 0.004). The additional cost associated with a reduction in hospital stay was calculated by determining the incremental cost-effectiveness ratio (ICER, difference in mean costs/difference in mean length of stay = $1604.51).
  
  
  CONCLUSIONS
  Endovascular repair continues to be more expensive than standard open repair determined according to procedural and follow-up costs. The technology is still in the developmental stage, but as it evolves and follow-up protocols are streamlined, it is hoped that there will be an eventual reduction in the costs associated with the endovascular procedure.
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont. Tom.Forbes@lhsc.on.ca
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
authors.forename: Guy
authors.initials: G
authors.lastname: DeRose
authors.forename: Stewart
authors.initials: S
authors.lastname: Kribs
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Harris
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics*; D003362:Cost-Benefit Analysis; D017721:Hospital Costs; D006801:Humans; D009864:Ontario; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000191:economics