EVAR had an incremental cost-effectiveness ratio of 110,000 pounds per QALY compared with open repair in fit patients, and 8,579 pounds per QALY versus conservative management in unfit patients.
Is EVAR cost-effective compared to open repair or conservative management in patients with abdominal aortic aneurysm?
EVAR is likely a cost-effective alternative to non-operative management in patients unfit for open repair, but not cost-effective compared to open repair in fit patients.
Effect estimate: ICER 110,000 pound per QALY (RC1); 8579 pound per QALY (RC2)
BACKGROUND: The rapid introduction of endovascular abdominal aortic aneurysm repair (EVAR) has considerable implications for the management of abdominal aortic aneurysm (AAA). This study was undertaken to determine an optimal strategy for the use of EVAR based on the best currently available evidence. METHODS: Economic modelling and probabilistic sensitivity analysis considered reference cases representing a fit 70-year-old with a 5.5-cm diameter AAA (RC1) and an 80-year-old with a 6.5-cm AAA unfit for open surgery (RC2). Results were assessed as incremental cost-effectiveness ratio (ICER) compared with open repair (RC1) or conservative management (RC2). RESULTS: In RC1 EVAR produced a gain of 0.10 quality-adjusted life years (QALYs) for an estimated cost of 11,449 pound, giving an ICER of 110,000 pound per QALY. EVAR consistently had an ICER above 30,000 pound per QALY over a range of sensitivity analyses and alternative scenarios. In RC2 EVAR produced an estimated benefit of 1.64 QALYs for an incremental cost of 14,077 pound giving an incremental cost per QALY of 8579 pound. CONCLUSION: : It is unlikely that EVAR for fit patients suitable for open repair is within the commonly accepted range of cost-effectiveness for a new technology. For those unfit for conventional open repair it is likely to be a cost-effective alternative to non-operative management. Sensitivity analysis suggests that research efforts should concentrate on determining accurate rates for late complications and reintervention, particularly in patients with high operative risks.
Michaels et al. (2005) studied Abdominal aortic aneurysm. Endovascular abdominal aortic aneurysm repair (EVAR) vs. Open repair or conservative management was evaluated on Incremental cost-effectiveness ratio (ICER) (ICER 110,000 pound per QALY (RC1); 8579 pound per QALY (RC2)). EVAR had an incremental cost-effectiveness ratio of 110,000 pounds per QALY compared with open repair in fit patients, and 8,579 pounds per QALY versus conservative management in unfit patients.