A recent economic analysis of elective endovascular aneurysm repair (EVAR) in high-risk patients suggests that this approach is a cost effective strategy compared to open surgery repair (OSR).
The study, which appears in the October issue of the Journal of Vascular Surgery, also showed that the average one-year costs of EVAR and open surgery were nearly identical, despite the significantly more expensive endovascular procedural costs, which includes the $10,000 endograft.
Previous economic analyses of EVAR vs. OSR concluded that the endovascular approach was not cost-effective, but the studies focused on all comers and not just those at high-risk. In this review, the investigators, led by Dr Jean-Eric Tarride, McMaster University, Hamilton, Canada, evaluated high-risk patients only.
Data was collected from 342 patients who had an abdominal aortic aneurysm (AAA) of more than 5.5cm and required elective AAA repair at London Health Sciences Center (LHSC), London, Ontario, Canada, where EVAR has been used since 1997. Of the 192 patients at a high risk of postoperative complications, 140 received EVAR and 52 had OSR.
In this one-year non-randomised prospective study, demographic, medical, healthcare resource utilisation, cost and quality of life data were collected to determine incremental costs and effects associated with each of these procedures. Sensitivity analyses were conducted to extrapolate the one-year mortality results to a five-year time horizon under various assumptions regarding convergence of mortality rates and re-intervention rates (for EVAR patients only).
“Even with similar baseline characteristics, postoperative complications occurred more frequently in OSR patients at a high-risk of surgical complications,” said Dr Guy De Rose, LHSC and University of Western Ontario in London, Canada, co-author of the study. “The 30-day mortality rates were 0.7% for EVAR and 9.6% for OSR and significantly fewer EVAR patients had postoperative complications such as pulmonary oedema, pneumonia or sepsis. In addition, the EVAR patients spent less time in the hospital and were less likely to be admitted to the ICU.”
Similar costs for EVAR and open surgery
De Rose noted that, despite the cost of the endograft, the total average initial costs of hospitalisation for high-risk EVAR and OSR patients were similar ($28,139 vs. $31,181 respectively). He added that total one-year medical and indirect costs also were similar at $34,146 vs. $34,170 respectively. At one-year, all cause mortality was statistically lower in EVAR patients (7.1% vs. 17.3%). Five-year extrapolations indicated that EVAR may be cost effective compared to OSR in high-risk patients over the long-term.
“Our study found that EVAR was a cost effective strategy compared to OSR in high-risk patients and had lower postoperative complications and lower mortality rates,” said De Rose. He added that the quality of life experienced by the participating patients was similar between the two groups during the year following surgery.
“We are continuing to collect data on these patients and the longer-term results will provide more information regarding the cost effectiveness of EVAR compared to OSR in high risk patients,” explained De Rose.
The LHSC collaborated with the Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph’s Healthcare Hamilton/McMaster University in Hamilton, Ontario, Canada on the current study. This study was conducted at the request of the Ontario Ministry of Health and Long-Term Care to provide evidence to the Ontario Health Technology Advisory Committee to support policy recommendations regarding the use of EVAR in Ontario.
