Cost-Benefit Analysis of Endovascular Versus Open Abdominal Aortic Aneurysm Treatment

Abstract

Objective: To compare the costs and benefits of open versus endovascular repair of abdominal aortic aneurysm (AAA).Methods: a consecutive series of 29 elective patients (open treatment, N = 20 and endovascular treatment, N = 9) were compared retrospectively.Results: operating time was significantly shorter for endovascular treatment (mean 90 vs. 125 min, p = 0,026). No endovascular procedure was converted to open surgery; one early endoleak was seen which sealed spontaneously. Endovascular treatment resulted in a shorter ICU and hospital stay (0 days vs. 2 days, p.0,001 and 5 days vs. 11 days, p = 0,01 respectively). Mean total cost did not differ 361 938 BEF (9 048 Euro) vs. 382 995 BEF (9 575 Euro), p = 0,46. Endovascular treatment generated significantly less hospitalization costs (73 162 BEF or 1 829 Euro vs. 18 2740 BEF or 4 568 Euro, p = 0,001) but required a more expensive implant (153 293 BEF or 3 832 Euro vs. 38 296 BEF or 957 Euro, p = 0.001). Mean total cost for the patient was significantly higher in the endovascular treatment group (66 309 BEF or 1 658 Euro vs. 24969 BEF or 624 Euro, p = 0,003).Conclusion: our experience confirms the feasibility and safety of endovascular AAA treatment. It is associated with a shorter ICU and hospital stay and less morbidity. Overall cost for society does not differ significantly as the benefit of lower hospitalization costs is undone by the high cost of the endovascular graft.