Jacob J. Visser MS, Presenter: Nothing to Disclose

Marc R.H.M. van Sambeek MD, Abstract Co-Author: Nothing to Disclose

M. G. Myriam Hunink MD, PhD, Abstract Co-Author: Grant, W. L. Gore & Associates, Inc

Lukas C. van Dijk MD, PhD, Abstract Co-Author: Nothing to Disclose

Johanna L. Bosch PhD, Abstract Co-Author: Nothing to Disclose

To evaluate the cost-effectiveness of endovascular repair versus open surgery in the treatment of a ruptured abdominal aortic aneurysm (AAA) and to investigate whether performing further research to obtain additional information is justified.

A Markov decision model was developed to evaluate long-term survival, quality-adjusted life years (QALYs), and lifetime costs for a hypothetical cohort of patients with ruptured AAA managed with endovascular repair or open surgery. Clinical effectiveness data were derived from a prospective multicenter study and from the literature. Cost data were derived from hospital databases and the literature. Probabilistic sensitivity analyses were performed on uncertain model parameters. Value of information analysis was performed to estimate the benefit of future clinical cost-effectiveness research.

Quality-adjusted life expectancy was higher for endovascular repair than for open surgery (5.42 versus 4.85 QALY), and lifetime costs were lower for endovascular repair than for open surgery ($49,344 versus $50,765). This means that endovascular repair was superior to open surgery. In sensitivity analysis, the cost-effectiveness was influenced by short-term (i.e., 30-day) complications and mortality after endovascular repair. The value of information analysis indicated that future cost-effectiveness research in patients with ruptured AAA is justified and should concentrate on short-term costs and clinical effectiveness.

Our results suggest that endovascular repair yielded more QALYs and was also associated with lower lifetime costs compared with open surgery in patients with ruptured AAA. In addition, further research is justified and should concentrate on short-term costs and clinical effectiveness.

From a societal perspective, patients with ruptured abdominal aortic aneurysm (AAA) should be treated with endovascular repair.

Visser, J, van Sambeek, M, Hunink, M, van Dijk, L, Bosch, J, Endovascular Repair versus Open Surgery in Patients with Ruptured Abdominal Aortic Aneurysms: Cost-effectiveness and Value of Information Analysis.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009617.html