title: Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial.
abstract: OBJECTIVE
  Prior analysis in the Open vs Endovascular Repair Veterans Affairs (VA) Cooperative Study (CSP #498) demonstrated that survival, quality of life, and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm. The device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, abdominal aortic aneurysm repair, and total health care costs when different endograft systems are selected for the endovascular repair (EVR). Within each selected system, EVR costs are compared with open repair costs.
  
  
  METHODS
  The study randomized 881 patients to open (n = 437) or EVR (n = 444). Device selection was recorded before randomization; therefore, open repair controls were matched to each device cohort. Data were excluded for two low-volume devices, implanted in only 13 individuals, leaving 423 control and 431 endovascular patients: 166 Zenith (Cook Medical, Bloomington, Ind), 177 Excluder (W. L. Gore & Associates, Flagstaff, Ariz), and 88 AneuRx (Medtronic, Minneapolis, Minn). Mean device, hospitalization, and total health care costs from randomization to 2 years were compared. Health care utilization data were obtained from patients and national VA and Medicare data sources. VA costs were determined using methods previously developed by the VA Health Economics Resource Center. Non-VA costs were obtained from Medicare claims data and billing data from the patient's health care providers.
  
  
  RESULTS
  Implant costs were 38% of initial hospitalization costs. Mean device (range, $13,600-$14,400), initial hospitalization (range, $34,800-$38,900), and total health care costs at 2 years in the endovascular (range, $72,400-$78,200) and open repair groups (range, $75,600-$82,100) were not significantly different among device systems. Differences between endovascular and corresponding open repair cohorts showed lower mean costs for EVR (range, $3200-$8300), but these were not statistically different.
  
  
  CONCLUSIONS
  The implant costs of endovascular aneurysm repair are substantial. When evaluating total health care system expenditures, there is large individual variability in costs, and there is no significant difference at 2 years among systems or when an individual system is compared with open repair.
authors.affiliation: Veterans Affairs Medical Center, Madison, Wisc. Electronic address: ellis@surgery.wisc.edu.
authors.forename: Jon S
authors.initials: JS
authors.lastname: Matsumura
authors.affiliation: Veterans Affairs Medical Center, Hines, Ill.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minn.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Lederle
authors.affiliation: Veterans Affairs Medical Center, West Haven, Conn.
authors.forename: Tassos C
authors.initials: TC
authors.lastname: Kyriakides
authors.affiliation: Veterans Affairs Medical Center, Hines, Ill.
authors.forename: Ling
authors.initials: L
authors.lastname: Ge
authors.affiliation: Veterans Affairs Medical Center, Baltimore, Md.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000191:economics*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D017048:Health Care Costs; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D011474:Prosthesis Design; D015607:Stents / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs