Methods: A Markov decision model was developed to evaluate long-term survival, quality-adjusted life years (QALYs), and lifetime costs for a hypothetical cohort of patients with ruptured AAAs managed with endovascular repair or open surgery. Clinical effectiveness data were derived from a prospective multicenter study and from the literature. Cost data were derived from hospital databases and the literature. Probabilistic sensitivity analyses were performed on uncertain model parameters. Value of information analysis was performed to estimate the benefit of future clinical cost-effectiveness research. Costs and effects were transformed into one composite outcome, net monetary benefits. We considered $75,000 per QALY gained the threshold willingness to pay. The lifetime of the technology was estimated to be 5 years. The discount rate used was 3% per year. To identify what type of research would be of interest (e.g., short-term or long-term outcomes), we assessed the expected value of partial perfect information (EVPPI).

Results: Quality-adjusted life expectancy was higher for endovascular repair than for open surgery (5.42 versus 4.85 QALY), and lifetime costs were lower for endovascular repair than for open surgery ($49,344 versus $50,765). This means that endovascular repair was superior to open surgery. In sensitivity analysis, the cost-effectiveness was influenced by short-term (i.e., 30-day) complications and mortality after endovascular repair. The value of information analysis indicated that future cost-effectiveness research in patients with ruptured AAAs is justified and should concentrate on short-term costs and clinical effectiveness.

Conclusions: From a societal perspective, our results suggest that endovascular repair yielded more QALYs and was also associated with lower lifetime costs compared with open surgery in patients with ruptured AAAs. In addition, further research is justified and should concentrate on short-term costs and clinical effectiveness.