title: Long-term cost-effectiveness analysis of endovascular versus open repair for abdominal aortic aneurysm based on four randomized clinical trials.
abstract: BACKGROUND
  A number of published economic evaluations of elective endovascular aneurysm repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA) have come to differing conclusions about whether EVAR is cost-effective. This paper reviews the current evidence base and presents up-to-date cost-effectiveness analyses in the light of results of four randomized clinical trials: EVAR-1, DREAM, OVER and ACE.
  
  
  METHODS
  Markov models were used to estimate lifetime costs from a UK perspective and quality-adjusted life-years (QALYs) based on the results of each of the four trials. The outcomes included in the model were: procedure costs, surveillance costs, reintervention costs, health-related quality of life, aneurysm-related mortality and other-cause mortality. Alternative scenarios about complications, reinterventions and deaths beyond the trial were explored.
  
  
  RESULTS
  Models based on the results of the EVAR-1, DREAM or ACE trials did not find EVAR to be cost-effective at thresholds used in the UK (up to £30,000 per QALY). EVAR seemed cost-effective according to models based on the OVER trial. These results seemed robust to alternative model scenarios about events beyond the trial intervals.
  
  
  CONCLUSIONS
  These analyses did not find that EVAR is cost-effective compared with open repair in the long term in trials conducted in European centres. EVAR did appear to be cost-effective based on the OVER trial, conducted in the USA. Caution must be exercised when transferring the results of economic evaluations from one country to another.
authors.affiliation: Department of Applied Economics, University of Granada, Granada, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Epstein
authors.forename: M J
authors.initials: MJ
authors.lastname: Sculpher
authors.forename: J T
authors.initials: JT
authors.lastname: Powell
authors.forename: S G
authors.initials: SG
authors.lastname: Thompson
authors.forename: L C
authors.initials: LC
authors.lastname: Brown
authors.forename: R M
authors.initials: RM
authors.lastname: Greenhalgh
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000401:mortality / Q000601:surgery; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000191:economics* / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D011182:Postoperative Care / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome