Cost-effectiveness of Elective Endovascular Aneurysm Repair Versus Open Surgical Repair of Abdominal Aortic Aneurysms

被引：36
作者：
Burgers, L. T. [1 ,2 ]
Vahl, A. C. [3 ]
Severens, J. L. [1 ,2 ]
Wiersema, A. M. [4 ]
Cuypers, P. W. M. [5 ]
Verhagen, H. J. M. [6 ]
Redekop, W. K. [1 ,2 ]
机构：
[1] Erasmus Univ, Inst Med Technol Assessment, Rotterdam, Netherlands
[2] Erasmus Univ, Inst Hlth Policy & Management, Rotterdam, Netherlands
[3] Onze Lieve Vrouw Hosp, Dept Vasc Surg, Amsterdam, Netherlands
[4] Westfriesgasthuis, Dept Surg, Hoorn, Netherlands
[5] Catharina Hosp, Dept Vasc Surg, Eindhoven, Netherlands
[6] Erasmus MC, Dept Vasc Surg, Rotterdam, Netherlands
来源：
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY | 2016年 / 52卷 / 01期
关键词：
Aneurysm; Cost-effectiveness; EVAR; Surgery; RANDOMIZED-TRIAL; ECONOMIC-MODEL; DIABETIC FOOT; AAA REPAIR; UK; PREVENTION; CANADA; EVAR;
D O I：
10.1016/j.ejvs.2016.03.001
中图分类号：
R61 [外科手术学];
学科分类号：
摘要：
Objective/Background: The aim of this study was to estimate the lifetime cost-effectiveness of endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in the Netherlands, based on recently published literature. Methods: A model was developed to simulate a cohort of individuals (age 72 years, 87% men) with an abdominal aortic aneurysm (AAA) diameter of at least 5.5 cm and considered fit for both repairs. The model consisted of two sub-models that estimated the lifetime cost-effectiveness of EVAR versus OSR: (1) a decision tree for the first 30 post-operative days; and (2) a Markov model for the period thereafter (31 days-30 years). Results: In the base case analysis, EVAR was slightly more effective (4.704 vs. 4.669 quality adjusted life years) and less expensive ((sic)24,483 vs. (sic)25,595) than OSR. Improved effectiveness occurs because EVAR can reduce 30 day mortality risk, as well as the risk of events following the procedure, while lower costs are primarily due to a reduction in length of hospital stay. The cost-effectiveness of EVAR is highly dependent on the price of the EVAR device and the reduction in hospital stay, complications, and 30 day mortality. Conclusion: EVAR and OSR can be considered equally effective, while EVAR can be cost saving compared with OSR. EVAR can therefore be considered as a cost-effective solution for patients with AAAs. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
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页码：29 / 40
页数：12
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