An evaluation of the costs to health care institutions of endovascular aortic aneurysm repair

Background: Endovascular graft techniques hold great potential as a less in vasive means for the repair of aortic aneurysms, yet the impact of these ne w modalities remains poorly elucidated. Methods: Over a 10-month period at a single institution, 139 patients under went infrarenal aortic aneurysm repair through a traditional open surgical technique (OS group, 94 patients) or an endovascular approach (ES group, 45 patients). Coated polyester prostheses (Hemashield; Boston Scientific Corp oration, Boston, Mass) were used in the OS patients, whereas a modular niti nol polyester device (AneuRx; Medtronic, Sunnyvale, Calif) was used in the ES group. The hospital costs exclusive of professional charges were tabulat ed for the two groups using the hospital cost accounting system. Outliers w ere included in the data analysis. Results: The mean operating room time was longer in the OS group than in th e ES group (285 minutes vs 166 minutes). The average length of stay was als o longer in the OS group (9.7 days vs 3.2 days). Hospital costs related to the length of stay were higher in the OS group, including laboratory costs ($327 higher), pharmacy costs ($688 higher), and nursing costs ($780 higher ). Anesthesia costs were also higher in the OS group ($493 higher). Despite these marked differences, the total hospital cost averaged $7205 more in t he ES group, a finding that was driven by the cost of the implantable devic es themselves ($8976 in the ES group vs $597 in the OS group). Conclusions: Despite reductions in the length of hospitalization, the cost of care was substantially greater in patients undergoing endovascular aneur ysm repair than in patients in whom an open surgical technique was used. Th ese differences are driven by the cost of the endograft device itself, a co st that must not exceed $6000 if the economic impact of endovascular repair is to be in parity with traditional methods. Unless these economic dispari ties can be ameliorated, the economic impact of endovascular aneurysm repai r may limit the widespread application of this technology.