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Saturday, 22 October 2005
5

COST ANALYSIS OF ENDOVASCULAR REPAIR AND OPEN SURGERY IN PATIENTS WITH ACUTE ABDOMINAL AORTIC ANEURYSMS WITH ONE-YEAR FOLLOW-UP

Jacob J. Visser, BSc1, Marc R.H.M. Van Sambeek, MD, PhD1, M.G. Myriam Hunink, PhD, MD2, W.Ken Redekop, PhD1, Lukas C. Van Dijk, MD, PhD1, Johanna M. Hendriks, MD1, and Johanna L. Bosch, PhD1. (1) Erasmus MC, Rotterdam, Netherlands, (2) Erasmus Medical Center, Rotterdam, Netherlands

Purpose: To assess in-hospital costs and costs of one-year follow-up of endovascular aneurysm repair and conventional open surgery in patients with an acute infrarenal Aneurysm of the Abdominal Aorta.

Methods: In-hospital costs for all consecutive patients undergoing endovascular (n = 32) or open surgical repair (n = 34) of an acute infrarenal AAA from January 1, 2001 until December 31, 2004 were retrieved. Direct hospital costs of all patients were assessed using the resource utilization approach. The in-hospital costs and costs during one-year follow-up were assessed from a health care perspective. Patients who did not undergo a CT-scan before the procedure were excluded from the analysis. Costs of one-year follow-up were completed for 20 patients who underwent endovascular repair and 25 patients who underwent open surgical repair. The mean total in-hospital costs and the mean costs during one-year follow-up were calculated for each treatment group; we used the bootstrap resample method to estimate the 95% confidence interval. Costs between the treatment groups were compared with the Mann Whitney U-test. In uni- and multivariable analyses, we investigated the influence of clinical variables on the total in-hospital costs. Costs were expressed in 2003 Euros.

Results: Sex, age, and comorbidity did not differ significantly between the treatment groups (p > 0.05). In patients treated with open surgery, more ruptured AAAs were present. Mortality and postoperative complications were lower for endovascular repair, although not significantly so. The mean total in-hospital costs were significantly lower for endovascular repair compared to open surgical repair (€ 21,707 versus € 33,887; p = 0.03). The total costs including one-year follow-up were € 21,431 versus € 35,249 for patients who underwent endovascular repair and open surgical repair, respectively (p = 0.12). In multivariable analysis, complications had a significant influence on total in-hospital costs (2.36 times higher costs).

Conclusion: Assuming equal or better effectiveness for endovascular repair compared to open surgery, our results suggest that from an economic perspective patients with an acute AAA who are eligible for endovascular repair should be treated with this procedure


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See more of The 27th Annual Meeting of the Society for Medical Decision Making (October 21-24, 2005)