The cost-effectiveness of endovascular repair versus open surgical repair of abdominal aortic aneurysms: A decision analysis model

Purpose: Endovascular repair (EVR) is a less-invasive method for the treatm ent of abdominal aortic aneurysms (AAAs) as compared with open surgical rep air (OSR). The potential benefits of EVR include increased patient acceptan ce, less resource utilization, and cost savings. This study was designed to determine whether the EVR of AAAs is a cost-effective alternative to OSR Methods: A cost-effectiveness analysis was performed using a Markov decisio n analysis model to compute long-term survival rates in quality-adjusted li fe years and lifetime costs for a hypothetical cohort of patients who under went either OSR or EVR. Probability estimates of the different outcomes of the two alternative strategies were made on the basis of a review of the Li terature. The average costs of (1) the immediate hospitalization ($16,016 f or OSR, $20,083 for EVR), (2) the complications that resulted from each pro cedure, (3) the subsequent interventions, and (4) the surveillance protocol were determined on the basis of average resource utilization as reported i n the Literature and from our hospital's cost accounting system. Our measur e of outcome was the cost-effectiveness ratio. Results: For our base-case analysis (70-year-old men with 5-cm AAAs), EVR w as cost-effective with a cost-effectiveness ratio of $22,826-society usuall y is willing to pay for interventions with cost-effectiveness ratios of les s than $60,000 (eg, cost-effectiveness ratios for coronary artery bypass gr afting and dialysis are $9500 and $54,400, respectively). This conclusion d id not vary significantly with increases in procedural costs for EVR (ie, i f the cost of the endograft increased from $8000 to $12,000, EVR remained c ost-effective with a cost-effectiveness ratio of $32,881). The cost-effecti veness of EVR was critically dependent on EVR producing a large reduction i n the combined mortality and long-term morbidity rate (stroke, dialysis-dep endent renal failure, major amputation, myocardial infarction) as compared with OSR(ie, a reduction in the combined mortality and long-term morbidity rate of OSR from 9.1% to 4.7% made EVR no longer cost-effective). Conclusion: Despite the high cost of new technology and the need for close postoperative surveillance, EVR is a cost-effective alternative for the rep air of AAAs. However, the cost-effectiveness of this new technology is crit ically dependent on its potential to reduce morbidity and mortality rates a s compared with OSR EVR may not be cost-effective in medical centers where OSR can be performed with low risk.