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Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review

Published online by Cambridge University Press:  01 April 2007

Yvonne C. Jonk ,
Robert L. Kane ,
Frank A. Lederle ,
Roderick MacDonald ,
Andrea H. Cutting  and
Timothy J. Wilt
Yvonne C. Jonk
Affiliation:
University of Minnesota and Minneapolis VA Center for Chronic Disease Outcomes Research
Robert L. Kane
Affiliation:
University of Minnesota
Frank A. Lederle
Affiliation:
University of Minnesota and Minneapolis VA Center for Chronic Disease Outcomes Research
Roderick MacDonald
Affiliation:
Minneapolis VA Center for Chronic Disease Outcomes Research
Andrea H. Cutting
Affiliation:
Minneapolis VA Center for Chronic Disease Outcomes Research
Timothy J. Wilt
Affiliation:
University of Minnesota and Minneapolis VA Center for Chronic Disease Outcomes Research
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Abstract

Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options.

Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded.

Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival.

Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.

Keywords

Aortic aneurysmAbdominalCost-effectivenessSystematic reviewBlood vessel prosthesisSurgical proceduresOperative
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 205 - 215
Copyright
Copyright © Cambridge University Press 2007

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