Background: Endovascular repair of abdominal aortic aneurysms (AAA) is a ne
w minimally invasive method of aneurysm exclusion that has been adopted wit
h increasing enthusiasm, and with acceptable clinical results. It is import
ant, however, to assess new health-care technologies in terms of their econ
omic as well as their clinical impact. The aim of the present study was to
compare the total treatment costs for endovascular (EVR) and open surgical
repair (OSR) for AAA.
Methods: A retrospective review of patient hospital and outpatient records
for 62 patients undergoing either EVR (n = 31) or OSR (n = 31) was carried
out between June 1996 and October 1999. Resource utilization was determined
by a combination of patient clinical and financial accounting data. Costs
were determined for preoperative assessment, inpatient hospital stay, cost
of readmissions and follow up, and predicted lifetime follow-up costs.
Results: The two groups were well matched, with no significant difference w
ith respect to age, gender, maximum aneurysm diameter or comorbid factors.
Endovascular treatment resulted in a shorter intensive care unit (ICU) and
hospital stay (mean: 0.07 vs 2.9 days, P < 0.001; mean: 6.0 vs 12.4 days, P
< 0.001; respectively) and fewer postoperative complications (P = 0.003).
The cost of hospitalization was less for EVR ($7614 vs $15 092, P < 0.001),
but this was offset by the more costly vascular prosthesis ($10 284 vs $68
6). Costs were higher for the EVR group for preoperative assessment ($2328
vs $1540, P < 0.001) and follow up ($1284 vs $70, P < 0.001). Lifelong foll
ow up could be expected to cost an additional $4120 per patient after EVR.
Total lifetime treatment costs including costs associated with readmission
for procedure-related complications were higher for EVR ($26 909 vs $17 650
).
Conclusion: Treatment costs for endovascular repair are higher than convent
ional surgical repair due to the cost of the vascular pros thesis and the g
reater requirement for radiological imaging studies.