title: Cost-effectiveness at two years in the VA Open Versus Endovascular Repair Trial.
abstract: BACKGROUND
  Long-term clinical outcomes have been similar for endovascular and open repair of abdominal aortic aneurysm (AAA), increasing the importance of comparing cost-effectiveness.
  
  
  METHODS
  We compared data to two years from a multicenter randomized trial of 881 patients. Quality-adjusted life years (QALYs) were calculated from EQ-5D questionnaires. Healthcare utilization data were obtained from patients and from national VA and Medicare sources. VA costs were obtained using methods previously developed by the VA Health Economics Resource Center. Costs for non-VA care were determined from Medicare or billing data.
  
  
  RESULTS
  Mean life-years were 1.78 in the endovascular and 1.74 in the open repair group (P = 0.29), and mean QALYs were 1.462 in the endovascular and 1.461 in the open group (P = 0.78). Although graft costs were higher in the endovascular group ($14,052 vs. $1363; P < 0.001), length of stay was shorter (5.0 vs. 10.5 days; P < 0.001), resulting in lower cost of AAA repair hospitalization in the endovascular group ($37,068 vs. $42,970; P = 0.04). Costs remained lower after 2 years in the endovascular group but the difference was no longer significant (-$5019; 95% CI: -$16,720 to $4928; P = 0.35). The probability that endovascular repair was both more effective and less costly was 70.9% for life-years and 51.4% for QALYs.
  
  
  CONCLUSIONS
  Endovascular repair is a cost-effective alternative to open repair in the US VA healthcare system for at least the first two years.
authors.affiliation: Department of Medicine (III-0), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis MN 55417, United States. frank.lederle@va.gov
authors.forename: F A
authors.initials: FA
authors.lastname: Lederle
authors.forename: K T
authors.initials: KT
authors.lastname: Stroupe
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs