An Analysis of Cost-Effectiveness and Clinical Outcomes of a Comprehensive Aortic Service in a Tertiary Center over One Year

Abstract

ObjectivesEndovascular aortic repair (EVAR) is an established and attractive alternative to open surgical repair (OSR) of abdominal aortic aneurysms (AAA) due to its superior short-term safety profile. However, opinions are divided regarding its long-term cost-effectiveness.We compared the total yearly cost of running endovascular and OSR services in a single tertiary centre, to determine whether fenestrated EVAR (FEVAR) represents a clinically efficacious, affordable treatment option. Design and MethodsA single centre retrospective review was performed on 109 patients undergoing a procedure related to index or previous abdominal aortic repair, with one year follow up. Data was collected from the National Vascular Registry and hospital records. The primary outcome was cost per QALY. Secondary outcomes included 30-day mortality and morbidity, re-intervention rates, length of hospital stay, aneurysm and all-cause mortality at one year for elective index procedures. ResultsThe average cost per patient of all FEVAR was £16,041.53 (+/-8,857.54), £13,893.51 (+/-£21,425.25) for standard EVAR, and £15,357.22 (+/-£15,904.49) for OSR (FEVAR vs EVAR p=.55, FEVAR vs OSR p=.83, OSR vs EVAR p=.76). Of the secondary outcomes, significant findings included increased length of stay and respiratory morbidity for patients undergoing open versus endovascular repair. There was no significant difference in 30-day or one-year mortality between groups. ConclusionFEVAR, EVAR and OSR all represent cost-effective options for aortic repair, with similar outcomes. Our data highlights the potential for FEVAR to present a viable alternative to open repair, particularly in higher risk groups, when performed in specialist centres.