Endovascular Aneurysm Repair Offers Better Results than Open Surgical Repair in High-Risk Patients
September 30, 2008 - Endovascular aneurysm repair (EVAR) yields better results than open surgical repair (OSR) in high-risk patients with similar costs, according to a one-year trial study, which appears in the October issue of the Journal of Vascular Surgery, published by the Society for Vascular Surgery.
Data was collected from 342 patients who had an abdominal aortic aneurysm (AAA) of more than 5.5 cm and required elective AAA repair at London Health Sciences Center (LHSC), London, Ontario, Canada, where EVAR has been used since 1997. Of the 192 patients at a high risk of postoperative complications, 140 received EVAR and 52 had OSR.
In this one-year non-randomized prospective study, demographic, medical, healthcare resource utilization, cost and quality of life data were collected to determine incremental costs and effects associated with each of these procedures. Sensitivity analyses were conducted to extrapolate the one-year mortality results to a five-year time horizon under various assumptions regarding convergence of mortality rates and re-intervention rates (for EVAR patients only).
“Even with similar baseline characteristics, postoperative complications occurred more frequently in OSR patients at a high-risk of surgical complications,” said Dr. Guy De Rose, M.D., medical director of surgical care at LHSC and an associate professor of surgery from the division of vascular surgery at the University of Western Ontario in London, Ontario, Canada. “The 30-day mortality rates were 0.7 percent for EVAR and 9.6 percent for OSR and significantly fewer EVAR patients had postoperative complications such as pulmonary edema, pneumonia or sepsis. In addition, the EVAR patients spent less time in the hospital and were less likely to be admitted to the ICU.”
Dr. De Rose noted despite the cost of the endograft (approximately $10,000), the total average initial costs of hospitalization for high-risk EVAR and OSR patients were similar ($28,139 vs. $31,181 respectively). He added that total one-year medical and indirect costs also were similar at $34,146 vs. $34,170 respectively. At one-year, all cause mortality was statistically lower in EVAR patients (7.1 vs. 17.3 percent). Five-year extrapolations indicated that EVAR might be cost-effective compared to OSR in high-risk patients over the long-term.
“Our study found that EVAR was a cost-effective strategy compared to OSR in high-risk patients and had lower postoperative complications and lower mortality rates,” said Dr. De Rose. He added that the quality of life experienced by the participating patients was similar between the two groups during the year following surgery.
“We are continuing to collect data on these patients and the longer-term results will provide more information regarding the cost-effectiveness of EVAR compared to OSR in high risk patients,” explained Dr. De Rose.
The LHSC collaborated with the Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph's Healthcare Hamilton/McMaster University in Hamilton, Ontario, Canada on the current study. This study was conducted at the request of the Ontario Ministry of Health and Long-Term Care to provide evidence to the Ontario Health Technology Advisory Committee to support policy recommendations regarding the use of EVAR in Ontario.
For more information: www.jvascsurg.org, www.VascularWeb.org
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