title: Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm.
abstract: BACKGROUND
  Patients with a large unruptured abdominal aortic aneurysm with a diameter >5.0 cm are treated with open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Because many studies have assessed the cost-effectiveness of these treatments with conflicting results, this systematic review examined published cost-effectiveness analyses of elective EVAR vs OSR in patients with abdominal aortic aneurysm.
  
  
  METHODS
  A systematic search strategy using three databases was conducted to find all relevant studies. Characteristics extracted from these studies included study characteristics (eg, age of the population), input parameters (eg, costs of the EVAR procedure), general results, and sensitivity analyses. The quality of each study was assessed using the Drummond checklist.
  
  
  RESULTS
  The search identified 1141 potentially relevant studies, of which 13 studies met inclusion criteria. Most studies found that EVAR was more expensive and more effective than OSR. However, most studies concluded that the health gained from EVAR did not offset the higher total costs, leading to an unacceptably high incremental cost-effectiveness ratio. EVAR was considered more cost-effective in patient groups with a high surgical risk. The quality of most studies was judged as reasonably good.
  
  
  CONCLUSIONS
  Overall, published cost-effectiveness analyses of EVAR do not provide a clear answer about whether elective EVAR is a cost-effective solution because the incremental cost-effectiveness ratio varies considerably among the studies. This answer can best be provided through a cost-effectiveness analysis of EVAR that incorporates more recent technologic advances and the improved experience that clinicians have with EVAR.
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Cornelis A
authors.initials: CA
authors.lastname: van Bochove
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. Electronic address: ltburgers@gmail.com.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Burgers
authors.affiliation: Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Anco C
authors.initials: AC
authors.lastname: Vahl
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Birnie
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Marien G
authors.initials: MG
authors.lastname: van Schothorst
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: William K
authors.initials: WK
authors.lastname: Redekop
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics*