Modelling the long-term cost-effectiveness of endovascular or open repair for abdominal aortic aneurysm.
BACKGROUND
Recent randomized trials have shown that endovascular abdominal aortic aneurysm repair (EVAR) has a 3 per cent aneurysm-related survival benefit in patients fit for open surgery, but it also has uncertain long-term outcomes and higher costs. This study assessed the cost-effectiveness of EVAR.


METHODS
A decision model was constructed to estimate the lifetime costs and quality-adjusted life years (QALYs) with EVAR and open repair in men aged 74 years. The model includes the risks of death from aneurysm, other cardiovascular and non-cardiovascular causes, secondary reinterventions and non-fatal cardiovascular events. Data were taken largely from the EVAR trial 1 and supplemented from other sources.


RESULTS
Under the base-case (primary) assumptions, EVAR cost 3800 pounds sterling (95 per cent confidence interval (c.i.) 2400 pounds sterling to 5200 pounds sterling) more per patient than open repair but produced fewer lifetime QALYs (mean -0.020 (95 per cent c.i. -0.189 to 0.165)). These results were sensitive to alternative model assumptions.


CONCLUSIONS
EVAR is unlikely to be cost-effective on the basis of existing devices, costs and evidence, but there remains considerable uncertainty.
Epstein
D M
DM
Centre for Health Economics, University of York, York, UK. dme2@york.ac.uk
Sculpher
M J
MJ
Manca
A
A
Michaels
J
J
Thompson
S G
SG
Brown
L C
LC
Powell
J T
JT
Buxton
M J
MJ
Greenhalgh
R M
RM
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D004724:Endoscopy / Q000191:economics* / Q000401:mortality; D006801:Humans; D008297:Male; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors