Key result
Endovascular aneurysm repair dominated open surgical repair for acute abdominal aortic aneurysms, yielding higher mean QALYs (3.09 vs 2.49) and lower costs (£17,422 vs £18,930 per patient).
Why the study?
Is endovascular aneurysm repair cost-effective compared to open surgical repair for patients presenting with acute abdominal aortic aneurysms?
Is endovascular aneurysm repair cost-effective compared to open surgical repair for patients presenting with acute abdominal aortic aneurysms?
Mean Difference: 0.64
Absolute Event Rate: 3.09% vs 2.49%
Emergency endovascular aneurysm repair for acute abdominal aortic aneurysms is highly likely to be cost-effective compared to open surgical repair, providing more QALYs at a lower cumulative cost.
May support endovascular dominance for acute AAA on QALYs and cost; leaves open confirmation in randomized trials.
PURPOSE: To present an economic evaluation of endovascular versus open surgical repair of ruptured abdominal aortic aneurysms (AAA). METHODS: Endovascular aneurysm repair (EVAR) is currently being appraised by the National Institute for Clinical Excellence. To aid in this appraisal, a health economic model developed to demonstrate the cost-effectiveness of EVAR for elective treatment of non-ruptured AAAs versus OSR was used for an analysis in the emergency setting. The base case data on 730 patients undergoing EVAR was extracted from our recently published 22-study meta-analysis of 7040 patients presenting with acute AAA (ruptured or symptomatic) treated with either emergency EVAR or OSR. These data reflected a patient population with an average age of 70 years. The base case model, which assumed a time horizon of 30 years and applied all-cause mortality rates, was subjected to a number of 1-way sensitivity analyses. A multivariate analysis was undertaken using 10,000 Monte-Carlo simulations. RESULTS: EVAR dominated OSR in the base case analysis, with a mean cumulative cost/patient of pound17,422 ($26,133) for EVAR and pound18,930 ($28,395) for OSR [- pound1508 ($2262) difference]. The mean quality-adjusted life years (QALYs)/patient was 3.09 for EVAR versus 2.49 for OSR (0.64 difference). EVAR was cost-effective compared with OSR at a threshold value of pound20,000 to pound30,000 ($30,000-$45,000)/QALY. In no single combination tested did open surgical repair provide the patient with more QALYs than EVAR. Sensitivity analyses demonstrated that the results were most sensitive to length of hospital and intensive care stays, use of blood products, and the cost of the evar device, which were the main cost drivers. CONCLUSION: While the UK's National Institute for Clinical Excellence does not set an absolute limit at which treatments would not be funded, pound30,000 ($45,000) is generally regarded as the upper limit of acceptability. At this level, there is almost a 100% probability that EVAR is a cost-effective treatment for ruptured AAA.
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Hayes et al. (2010) studied Acute abdominal aortic aneurysms (ruptured or symptomatic) (n=7,040). Endovascular aneurysm repair (EVAR) vs. Open surgical repair (OSR) was evaluated on Mean quality-adjusted life years (QALYs) per patient (MD 0.64). Endovascular aneurysm repair dominated open surgical repair for acute abdominal aortic aneurysms, yielding higher mean QALYs (3.09 vs 2.49) and lower costs (£17,422 vs £18,930 per patient).
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