PC168. Cost-Effectiveness Analysis of Open Surgical Repair versus Fenestrated Endovascular Repair of Pararenal Aneurysms

Abstract

With advances in endovascular technology pararenal abdominal aortic aneurysms (pAAA) may be treated with fenestrated endovascular aneurysm repair (FEVAR). Although the length of hospital stay is shorter compared with open surgical repair (OSR) reintervention rates and need for ongoing surveillance may lead to long-term higher costs. The goal of this study was to evaluate the long-term cost-effectiveness of FEVAR and OSR for elective pAAA repair. Using a Markov model we evaluated costs from the societal perspective using Medicare reimbursements in 2017 US dollars and Quality Adjusted Life Years (QALYs) to calculate the incremental cost-effectiveness ratio (ICER) between the two surgical strategies. Published literature regarding short-term and long-term clinical outcomes of FEVAR and OSR were used to evaluate re-interventions rates, follow-up imaging practices and complications after a procedure leading to chronic complications such as hemodialysis, myocardial infarction, and stroke. Studies regarding infrarenal AAA were imputed if data regarding pAAA was unavailable. Sensitivity analysis was performed on model input variables with high uncertainty. Our model found an incremental cost of $6360 and incremental QALY of 0.30 with elective FEVAR resulting in an incremental cost-effectiveness ratio (ICER) of $21,200 per QALY. The probability of patients who required hemodialysis as a complication of FEVAR, cost of FEVAR and OSR, as well as re-intervention rates after FEVAR had the greatest significant effects on the ICER. A tornado diagram shows variables affecting the ICER with the largest effect from the top (Fig). Our analysis indicates that although overall FEVAR costs may be higher, the QALY gained makes it a cost-effective treatment for pAAA. However, limitations in the primary data and individual patient factors preclude definitive assessment and broad validation. Future work needs to examine costs from the hospital perspective and analyze individual patient factors.