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• W2106996502 abstract "Conclusion: Endovascular aneurysm repair (EVAR) is not cost-effective. Summary: EVAR has been shown in recent randomized trials to have a 3% aneurysm-related survival benefit compared with open surgery in patients who are suitable for both open and EVAR of an abdominal aortic aneurysm (AAA). EVAR has a high graft-related cost, a need for long-term follow-up, and an uncertain long-term outcome. This study used a decision model to estimate lifetime costs and quality-adjusted life-years with EVAR and open AAA repair in men aged 74 years. Risk of death from aneurysm-related causes, other cardiovascular causes, and noncardiovascular causes, as well as nonfatal cardiovascular events and reinterventions, were incorporated into the model. The patients were assumed to be 74 years old because this was the mean age of participants in EVAR-1. The measure of health benefit was expected quality-adjusted survival duration. All costs were measured in United Kingdom pounds based on 2004 pricing. Both health benefits and costs in future years were discounted at a rate of 3.5% per year. Most of the data used in the modeling was from the EVAR-1 trial, but it was supplemented by data from population tables, registries, and the Dutch Randomised Endovascular Aneurysm Management (DREAM) trial. Because both EVAR-1 and the DREAM trial found no late survival benefit, an increased risk of cardiovascular mortality was assumed in the EVAR-treated patients. This risk was varied in sensitivity analysis in the model. Using base-case (primary assumptions), EVAR was found to cost £3800 (95% confidence interval [CI], £2400-£5200) more per patient than open repair. EVAR also produced fewer lifetime quality-adjusted life-years (mean, −0.020; 95% CI, −0.189 to 0.165) than open repair. The results remain sensitive to alternative model assumptions. Comment: The data indicate, at least from the perspective of the National Health Service in the United Kingdom, that EVAR is unlikely to be cost-effective. The cost of EVAR is largely driven by the cost of the devices, which are ultimately, as the authors pointed out, under the control of the manufacturers. When all factors are considered, EVAR is not proving to be the “home run” that it was touted to be. At some point the cost of increasing medical technology is going to prove to be prohibitive. Both vascular surgeons and industry may be wise to be proactive in controlling costs of EVAR." @default.
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• W2106996502 date "2008-07-01" @default.
• W2106996502 modified "2023-09-30" @default.
• W2106996502 title "Modeling the Long-term Cost-Effectiveness of Endovascular or Open Repair for Abdominal Aortic Aneurysm" @default.
• W2106996502 doi "https://doi.org/10.1016/j.jvs.2008.05.048" @default.
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