Cost-effectiveness and cost-utility of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Amsterdam Acute Aneurysm Trial.
BACKGROUND
Minimally invasive endovascular aneurysm repair (EVAR) could be a surgical technique that improves outcome of patients with ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to analyse the cost-effectiveness and cost-utility of EVAR compared with standard open repair (OR) in the treatment of rAAA, with costs per 30-day and 6-month survivor as outcome parameters.


METHODS
Resource use was determined from the Amsterdam Acute Aneurysm (AJAX) trial, a multicentre randomized trial comparing EVAR with OR in patients with rAAA. The analysis was performed from a provider perspective. All costs were calculated as if all patients had been treated in the same hospital (Onze Lieve Vrouwe Gasthuis, teaching hospital).


RESULTS
A total of 116 patients were randomized. The 30-day mortality rate was 21 per cent after EVAR and 25 per cent for OR: absolute risk reduction (ARR) 4·4 (95 per cent confidence interval (c.i.) -11·0 to 19·7) per cent. At 6 months, the total mortality rate for EVAR was 28 per cent, compared with 31 per cent among those assigned to OR: ARR 2·4 (-14·2 to 19·0) per cent. The mean cost difference between EVAR and OR was €5306 (95 per cent c.i. -1854 to 12,659) at 30 days and €10,189 (-2477 to 24,506) at 6 months. The incremental cost-effectiveness ratio per prevented death was €120,591 at 30 days and €424,542 at 6 months. There was no significant difference in quality of life between EVAR and OR. Nor was EVAR superior regarding cost-utility.


CONCLUSIONS
EVAR may be more effective for rAAA, but its increased costs mean that it is unaffordable based on current standards of societal willingness-to-pay for health gains.
Division of Vascular Surgery, Department of Surgery, Amsterdam, The Netherlands.
M R
MR
Kapma
L M
LM
Dijksman
J J
JJ
Reimerink
A J
AJ
de Groof
C J
CJ
Zeebregts
W
W
Wisselink
R
R
Balm
M G W
MG
Dijkgraaf
A C
AC
Vahl
D000208:Acute Disease; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000191:economics* / Q000401:mortality / Q000601:surgery; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000191:economics* / Q000401:mortality; D017721:Hospital Costs; D006801:Humans; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015607:Stents / Q000191:economics; D013525:Surgical Instruments / Q000191:economics