title: Midterm cost and effectiveness of thoracic endovascular aortic repair versus open repair.
abstract: BACKGROUND
  Thoracic endovascular aneurysm repair (TEVAR) has been rapidly introduced as a primary treatment modality for thoracic aortic diseases with limited data available on midterm to late-term outcomes.
  
  
  METHODS
  A retrospective single institution study comparing hospital and midterm outcomes and costs for TEVAR versus open elective repair of descending thoracic aneurysms was conducted. Fifty-seven patients were included between 2005 and 2007 (TEVAR=28; open=29) and were followed until May 2010.
  
  
  RESULTS
  Patients in the TEVAR group were older (73.2 versus 62.3 years; p<0.001). Hospital mortality was higher in the open repair group (10.3% versus 3.6%; p=0.611). There was no statistical difference in stroke, paraparesis or paralysis, sepsis, or renal failure; however, a composite major adverse event variable showed a higher complication with open repair versus TEVAR (37.9% versus 14.3%; p=0.043). Mean follow-up was 42.6 months for open repair versus 26.9 for TEVAR (p=0.002). Kaplan-Meier survival analysis showed the initial survival benefit for TEVAR was lost in less than 6 months; however, the difference did not reach statistical significance during follow-up (log-rank test p=0.232). Mean surveillance imaging costs for a TEVAR patient were $1,800.38 higher than for an open patient at 2 years. Compliance of TEVAR patients with follow-up imaging was 78%, 64%, 50%, and 42% at 1, 6, 12, and 24 months, respectively, and was even lower in those not registered in device trials.
  
  
  CONCLUSIONS
  Patients in the TEVAR group had favorable early outcomes; however, midterm survival was reduced secondary to comorbidities. This study raises concern for the ongoing costs of surveillance imaging in TEVAR as well as patient compliance with follow-up.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida, College of Medicine, Gainesville, Florida 32610-0129, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Karimi
authors.forename: Karen L
authors.initials: KL
authors.lastname: Walker
authors.forename: Tomas D
authors.initials: TD
authors.lastname: Martin
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Hess
authors.forename: Charles T
authors.initials: CT
authors.lastname: Klodell
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Feezor
authors.forename: Adam W
authors.initials: AW
authors.lastname: Beck
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Beaver
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000191:economics / Q000453:epidemiology; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000191:economics / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics* / Q000379:methods; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging / Q000191:economics; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000191:economics*; D005260:Female; D005431:Florida; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D056346:Sternotomy / Q000191:economics*; D016896:Treatment Outcome