title: Thoracic endovascular repair versus open surgical repair - which is the more cost-effective intervention for descending thoracic aortic pathologies?
abstract: OBJECTIVE
  Endovascular treatment is increasingly used to treat complicated aortic pathology. The aim of the study was to assess if compared with operative repair, thoracic endovascular repair of aorta (TEVAR) was associated with a cost benefit in management of diseases affecting the descending thoracic aorta. We also compared early and mid-term outcomes between the two groups.
  
  
  METHODS
  Clinical characteristics, outcomes and hospitalisation costs of 84 consecutive patients undergoing intervention for conditions affecting the descending thoracic aorta were reviewed retrospectively. Hospitalisation costs were calculated from National Health Service (NHS) reference costs for staff time, consumables, transfusion and length of stay.
  
  
  RESULTS
  Apart from a higher frequency of acute type B dissection (16/45 vs 5/39, p = 0.047) in the TEVAR group, the baseline characteristics were similar. TEVAR was associated with significant reductions in morbidity (renal dysfunction 11 (31%) vs 5 (10%) p=0.025; in-hospital death 7 (20%) vs 3 (6%), p = 0.03; median intensive therapy unit (ITU) stay 6 (3-11) vs 1 (1-4), p < 0.0001). TEVAR was associated with significantly increased procedural costs (£2468 (€2961) vs £9581 (€11495) p ≤ 0.0001). This was chiefly attributable to the cost of endovascular stents. There was no significant difference in overall hospitalisation costs. TEVAR was associated with significantly lower freedom from death or re-operation (log rank p=0.048).
  
  
  CONCLUSIONS
  TEVAR is associated with reduced morbidity and mortality in the short term. However, no cost benefit was seen with TEVAR even in the short term. In the long term, due to increased risk of re-interventions TEVAR may actually prove to be a more expensive therapeutic option.
authors.affiliation: Department of Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Narayan
authors.forename: Alex
authors.initials: A
authors.lastname: Wong
authors.forename: Ian
authors.initials: I
authors.lastname: Davies
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bryan
authors.forename: Peter
authors.initials: P
authors.lastname: Wilde
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000191:economics / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000191:economics / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000191:economics* / Q000379:methods; D004739:England; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics; D016896:Treatment Outcome