Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review

Yvonne C. Jonk, Robert L. Kane, Frank A. Lederle, Roderick MacDonald, Andrea H. Cutting, Timothy J. Wilt

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options. Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded. Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival. Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.

Original languageEnglish (US)
Pages (from-to)205-215
Number of pages11
JournalInternational Journal of Technology Assessment in Health Care
Volume23
Issue number2
DOIs
StatePublished - Apr 1 2007

Fingerprint

Abdominal Aortic Aneurysm
Cost-Benefit Analysis
Costs and Cost Analysis
Length of Stay
Aortic Rupture
Survival
Hospital Costs
Therapeutics
Critical Care
MEDLINE
Blood Transfusion
Prostheses and Implants
Randomized Controlled Trials
Quality of Life

Keywords

  • Abdominal
  • Aortic aneurysm
  • Blood vessel prosthesis
  • Cost-effectiveness
  • Operative
  • Surgical procedures
  • Systematic review

ASJC Scopus subject areas

  • Health Policy

Cite this

Cost-effectiveness of abdominal aortic aneurysm repair : A systematic review. / Jonk, Yvonne C.; Kane, Robert L.; Lederle, Frank A.; MacDonald, Roderick; Cutting, Andrea H.; Wilt, Timothy J.

In: International Journal of Technology Assessment in Health Care, Vol. 23, No. 2, 01.04.2007, p. 205-215.

Research output: Contribution to journalReview article

Jonk, Yvonne C. ; Kane, Robert L. ; Lederle, Frank A. ; MacDonald, Roderick ; Cutting, Andrea H. ; Wilt, Timothy J. / Cost-effectiveness of abdominal aortic aneurysm repair : A systematic review. In: International Journal of Technology Assessment in Health Care. 2007 ; Vol. 23, No. 2. pp. 205-215.
@article{4847c23ea1c34d31a84b3bacfb5f12bf,
title = "Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review",
abstract = "Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options. Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded. Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival. Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.",
keywords = "Abdominal, Aortic aneurysm, Blood vessel prosthesis, Cost-effectiveness, Operative, Surgical procedures, Systematic review",
author = "Jonk, {Yvonne C.} and Kane, {Robert L.} and Lederle, {Frank A.} and Roderick MacDonald and Cutting, {Andrea H.} and Wilt, {Timothy J.}",
year = "2007",
month = "4",
day = "1",
doi = "10.1017/S0266462307070316",
language = "English (US)",
volume = "23",
pages = "205--215",
journal = "International Journal of Technology Assessment in Health Care",
issn = "0266-4623",
publisher = "Cambridge University Press",
number = "2",

}

TY - JOUR

T1 - Cost-effectiveness of abdominal aortic aneurysm repair

T2 - A systematic review

AU - Jonk, Yvonne C.

AU - Kane, Robert L.

AU - Lederle, Frank A.

AU - MacDonald, Roderick

AU - Cutting, Andrea H.

AU - Wilt, Timothy J.

PY - 2007/4/1

Y1 - 2007/4/1

N2 - Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options. Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded. Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival. Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.

AB - Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options. Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded. Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival. Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.

KW - Abdominal

KW - Aortic aneurysm

KW - Blood vessel prosthesis

KW - Cost-effectiveness

KW - Operative

KW - Surgical procedures

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=34247342678&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247342678&partnerID=8YFLogxK

U2 - 10.1017/S0266462307070316

DO - 10.1017/S0266462307070316

M3 - Review article

C2 - 17493306

AN - SCOPUS:34247342678

VL - 23

SP - 205

EP - 215

JO - International Journal of Technology Assessment in Health Care

JF - International Journal of Technology Assessment in Health Care

SN - 0266-4623

IS - 2

ER -