O011 An analysis of cost effectiveness and clinical outcomes of elective abdominal aortic aneursym repair in a tertiary centre over one year

Abstract

Abstract Introduction Endovascular aneurysm repair (EVAR) is an alternative to open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and has a superior short-term safety profile. However recent guidelines have questioned its long-term cost-effectiveness. We retrospectively compared EVAR, Fenestrated EVAR (FEVAR) and OSR of non-ruptured AAA in a tertiary centre over 12 months, to determine whether FEVAR represents an affordable, clinically efficacious option in aortic repair Methods Data was collected from the National Vascular Registry and hospital records.73 patients underwent primary elective AAA repair. Patients were followed up for one year post-operatively. The primary outcome was cost per QALY. Secondary outcomes included 30-day mortality and morbidity, aneurysm-related mortality, re-intervention rates, length of hospital stay and all-cause mortality at one year. Results Cost per QALY was calculated as £19134.75, £15408.00 and £12118.16 for FEVAR, EVAR and OSR respectively (FEVAR vs EVAR p= 0.438, FEVAR vs OSR p= 0.001, OSR vs EVAR p= 0.589) OSR was associated with a longer overall hospital and ITU stay, and significantly higher incidence of respiratory complications post-operatively compared to FEVAR and EVAR. FEVAR was associated with significantly higher operative costs, and higher re-intervention and readmission rates compared to EVAR and OSR. There was no significant difference between perioperative and one year mortality between the repair options. Conclusion FEVAR is more expensive than OSR but based on NICE willingness-to-pay thresholds, it still presents a viable alternative for aortic repair, when performed in specialist centres. However, long term data is required to make informed decisions on cost-effectiveness. Take-home message FEVAR represents a viable alternative for elective abdominal aortic repair. Long-term RCT data are required to make informed decisions on cost effectiveness