PC020. Health Care Costs of Endovascular Compared With Open Thoracoabdominal Aortic Aneurysm Repair

Abstract

The objective of this study was to compare 1-year health care costs of open and endovascular thoracoabdominal aortic aneurysm (TAAA) repair within a single-payer, public health care system. Population-based administrative health databases were used to capture TAAA repairs performed in Ontario, Canada, between January 2006 and March 2017. Health care costs to the Ministry of Health for these patients included those attributable to hospital stay, emergency department visits, inpatient rehabilitation, physician billing, outpatient nursing, and allied health care as well as outpatient medications, investigations, and all subsequent interventions. Costs of the aortic endografts and ancillary devices for the index procedure were determined to be C$44,000 per case vs C$1000 for open cases. Costs (2017 Canadian dollars) were calculated in phases (1 month, 1-3 months, 3-6 months, 6 months-1 year) with censoring for death. Propensity score matching based on 26 preoperative characteristics was employed to account for confounding by indication. The association between preoperative characteristics and 1-month cost was characterized through multivariable analysis. A total of 664 TAAA repairs were identified (open, n = 361 [54.5%]; endovascular, n = 303 [45.6%]), and 241 open and endovascular propensity score-matched pairs were identified. At 1 month, mean (median) total cost for the unmatched open TAAA group was C$46,575 (C$36,647; 77% hospital cost, 14% physician billings, 3% graft cost, 6% other), whereas for the endovascular group, total cost was C$72,581 (C$64,892; 67% graft cost, 27% hospital cost, 5% physician billings, 1% other; P < .01. On multivariable analysis, older age (P < .01), nonelective procedures (P < .01), and preoperative stroke (P = .05) were associated with increased costs at 1 month. At intervals of 1 to 3 months, 3 to 6 months, and 6 months to 1 year after the procedure, there were no significant differences in health care costs between groups (Table). Mean (median) cost for patients alive at 1 year were C$91,571 (C$52,003) vs C$103,740 (C$83,242; P < .01) for open (n = 264) and endovascular (n =206) TAAA repair, respectively. Similar costs were observed in the matched groups. Device costs were the primary driver of the higher costs of endovascular TAAA repair compared with open repair during the initial month. Increasing age, preoperative stroke, and nonelective procedures were associated with higher 1-month cost. Total health care costs after the first month and up to 1 year, which includes reinterventions, were not significantly different. Reducing device costs will help balance the costs of open and endovascular TAAA repair.TableHealth care costs (in Canadian dollars) of endovascular vs open thoracoabdominal aortic aneurysm (TAAA) repairCostUnmatchedPropensity score matchedOpenEndovascularP valueOpenEndovascularP valueMean (median)Mean (median)Mean (median)Mean (median)1 month46,575 (36,647)72,581 (64,892)<.0146,556 (33,605)72,786 (64,892)<.011-3 months19,826 (2024)11,292 (1977).6218,828 (1832)11,454 (1992).613-6 months12,289 (1173)11,453 (1508).169456 (1144)12,153 (1298).846 months-1year11,985 (2427)12,087 (2998).978840 (2524)12,016 (3050).34 Open table in a new tab