title: Cost-effectiveness of abdominal aortic aneurysm repair based on aneurysm size.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of endovascular repair (EVAR) for small abdominal aortic aneurysms (AAA).
  
  
  METHODS
  We developed a Markov model of a hypothetical 68-year-old cohort to determine the cost-effectiveness of early EVAR for "small" AAAs (4.0 cm-5.4 cm) compared with elective repair (open or endovascular) at the traditional cut-off of 5.5 cm. Repair options for 5.5-cm AAAs include both endovascular and open procedures. Probabilities were obtained from the literature. Costs reflected direct costs in 2007 dollars. Outcomes were reported as quality-adjusted life-years (QALYs).
  
  
  RESULTS
  The model demonstrated that early EVAR for 4.0 cm-5.4 cm AAAs led to fewer QALYs at greater costs when compared with observational management with elective repair at 5.5 cm. Sensitivity analyses suggested that early EVAR of 4.6 cm-4.9 cm AAAs can be cost-effective if the long-term mortality rate after EVAR is <or=1.91% per year or if the quality of life after EVAR is improved. Likewise, if the quality of life before repair is low, EVAR for AAAs >or=4.6 cm may be cost-effective. With a >70% probability, observational management until AAA diameter is 5.5 cm will be the cost-effective option.
  
  
  CONCLUSIONS
  This analysis demonstrated that early EVAR for AAAs <5.5 cm is not likely to be cost-effective compared with elective repair at 5.5 cm. However, EVAR for small AAAs may become cost-effective when differences in quality of life and mortality are considered.
authors.affiliation: Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. kate_young@urmc.rochester.edu
authors.forename: Kate C
authors.initials: KC
authors.lastname: Young
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Awad
authors.forename: Marcia
authors.initials: M
authors.lastname: Johansson
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Singh
authors.forename: Karl A
authors.initials: KA
authors.lastname: Illig
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D017558:Elective Surgical Procedures; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008390:Markov Chains; D019060:Minimally Invasive Surgical Procedures; D018803:Models, Economic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality