Elective Endovascular Aortic Aneurysm Repair Continues to Cost More than Open Abdominal Aortic Aneurysm Repair

Abstract

Endovascular aortic aneurysm repair (EVAR) is now established as first-line treatment for infrarenal aortic aneurysms in the United States. Recent data from randomized trials suggest that elective EVAR is cost-effective compared with open abdominal aortic aneurysm repair (oAAA). Cost analysis for urgent aneurysm repair has not been reported. We evaluated the cost of elective and urgent EVAR and compared it with oAAA at a tertiary academic medical center. All infrarenal AAA repairs performed from 2004 to 2010 were retrospectively reviewed (n=172). Clinical characteristics of patients receiving EVAR and oAAA repair were compared. Direct costs, payments, and direct cost margin for the index inpatient episode were obtained from the hospital for all patients. Subsequent financial information including clinical, radiologic, and procedural cost was also available for 52 patients who had received all follow-up care in our institution for at least 1 year (EVAR 34, oAAA 18). Overall, elective EVAR patients were older, but oAAA patients had more comorbidities, with significantly more patients having dyspnea at rest and being totally dependent for activities of daily living. EVAR patients had significantly shorter lengths of stay, regardless of urgency and urgent AAA repair occurred more often by oAAA than EVAR (P<0.001; χ2). For elective patients, EVAR costs were 34.21% greater than for oAAA. There was a trend toward lower costs with EVAR versus oAAA in patients treated urgently by a ratio of 1.28:1. The hospital experienced a negative cost margin more often after elective EVAR versus oAAA. Negative cost margins were less frequent following urgent repair but still occurred twice as often in EVAR versus oAAA patients. Cost margins remained negative in all EVAR patients for at least 1 year and only 18% converted to a positive cost margin at a mean of 31months. At a tertiary academic institution, costs for elective EVAR are significantly higher than oAAA. EVAR may be relatively more cost-effective in urgent situations. Negative cost margins were more common in EVAR patients and 1-year follow-up with imaging in the same institution did not result in a positive margin.