scholarly journals PC148. Cost-Effectiveness Analysis of Fenestrated Endovascular Aneurysm Repair Compared With Open Surgical Repair for Patients With Juxtarenal Abdominal Aortic Aneurysms

2019 ◽  
Vol 69 (6) ◽  
pp. e244-e245
Author(s):  
Elizabeth L. George ◽  
Lauren Nardacci ◽  
Prima Sinawang ◽  
Isabelle Rao ◽  
Douglas K. Owens ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Surgical Repair ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Cost Effectiveness Analysis ◽  
Aortic Aneurysms ◽  
Open Surgical Repair ◽  
Effectiveness Analysis ◽  
Abdominal Aortic ◽  
Aneurysm Repair

scholarly journals Cost-Effectiveness of Endovascular Aneurysm Repair Versus Open Surgical Repair for Ruptured Abdominal Aortic Aneurysms: A Systematic Review

2021 ◽  
Vol 18 (3) ◽  
Author(s):  
Zeinab Dolatshahi ◽  
Fateme Mezginejad ◽  
Shahin Nargesi ◽  
Moslem Saliminejad
Keyword(s):  
Cost Effectiveness ◽  
Surgical Repair ◽  
Endovascular Aneurysm Repair ◽  
Cost Effective ◽  
Aortic Aneurysms ◽  
Open Surgical Repair ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms ◽  
Aneurysm Repair

Context: If the diameter of an aneurysm increases by more than 6 cm, the risk of aortic rupture increases by 50% within 10 years. Therefore, rupture of aneurysm, which is usually asymptomatic, can lead to severe complications and increase the risk of mortality. The current study aimed to systematically review studies comparing the cost-effective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) as the primary treatment options for patients with ruptured abdominal aortic aneurysms (AAAs). Methods: An electronic search was conducted in PubMed, EMBASE, Science Direct, Scopus, and other scientific economic databases. Relevant articles were searched from 1999 to 2020 using keywords, such as “abdominal aortic aneurysm”, “endovascular”, “open surgery”, “rupture”, “economic evaluation”, and “cost-effectiveness”. The quality of articles was assessed using the Quality of Health Economic studies (QHES) checklist; finally, five articles were included in this review. Results: The results of the QHES checklist showed that most studies had a good quality. A third-party payer’s perspective was the dominant perspective in all selected studies, comparing EVAR with OSR. All studies considered the direct medical costs and did not disclose any discount rates, except for one study, reporting a 3.5% discount rate. Almost all included studies found EVAR to be a cost-effective intervention; only one study concluded that EVAR, with a cost-effectiveness ratio of €424,542, was not the best treatment option. Conclusion: In patients with ruptured AAAs, the EVAR intervention improved the quality of life, decreased the mortality rate, and shortened the hospital stay as compared to OSR.

scholarly journals The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: a systematic review and cost-effectiveness analysis

2014 ◽  
Vol 18 (70) ◽  
pp. 1-66 ◽  
Author(s):  
Nigel Armstrong ◽  
Laura Burgers ◽  
Sohan Deshpande ◽  
Maiwenn Al ◽  
Rob Riemsma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Study Design ◽  
Endovascular Aneurysm Repair ◽  
Clinical Effectiveness ◽  
Cost Effectiveness Analysis ◽  
Aortic Aneurysms ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
Effectiveness Analysis ◽  
Abdominal Aortic

BackgroundPatients with large abdominal aortic aneurysms (AAAs) are usually offered reparative treatment given the high mortality risk. There is uncertainty about how to treat juxtarenal AAAs (JRAAAs) or thoracoabdominal aortic aneurysms (TAAAs). Endovascular repair of an abdominal aortic aneurysm (EVAR) is often seen as safer and easier than open surgical repair (OSR). However, endovascular treatment of JRAAAs or TAAAs requires specially manufactured stent grafts, with openings to allow blood to reach branches of the aorta. Commissioners are receiving increasing requests for fenestrated EVAR (fEVAR) and branched EVAR (bEVAR), but it is unclear whether or not the extra cost of fEVAR or bEVAR is justified by advantages for patients.Objective(s)To assess the clinical effectiveness, safety and cost-effectiveness of fEVAR and bEVAR in comparison with conventional treatment (i.e. no surgery) or OSR for two populations: JRAAAs and TAAAs.Data sourcesResources were searched from inception to October 2013, including MEDLINE (OvidSP), EMBASE (OvidSP) and the Cochrane Central Register of Controlled Trials (Wiley) and, additionally, for cost-effectiveness, NHS Economic Evaluation Database (NHS EED; Wiley) and EconLit (EBSCOhost). Conference abstracts were also searched.Review methodsStudies were included based on an intervention of either fEVAR or bEVAR and a comparator of either OSR or no surgery. For clinical effectiveness, observational studies were excluded only if they were not comparative, i.e. explicitly selected on the basis of prognosis.ResultsFor clinical effectiveness, searches retrieved 5253 records before deduplication. Owing to overlap between the databases, 1985 duplicate records were removed. Of the remaining 3268 records, based on titles and abstracts, 3244 records were excluded, leaving 24 publications to be ordered. All 24 studies were excluded as none of them satisfied the inclusion criteria. Sixteen studies were excluded on study design, six on intervention and two on comparator. Five out of 16 studies excluded on study design reported a comparison. However, all of the studies acknowledged that they had groups that were not comparable at baseline given that they had selectively assigned younger, fitter patients to OSR. Therefore, these studies were considered ‘non-comparative’. For cost-effectiveness, searches identified 104 references before deduplication. Owing to overlap between the databases, 34 duplicate records were removed. Of the remaining 70 records, seven were included for the full assessment based on initial screening. After a full-text review, no studies were included. Because of the lack of clinical effectiveness evidence and difficulty in estimating costs given the rapidly changing and variable technology, a cost-effectiveness analysis (CEA) was not performed. Instead a detailed description of modelling methods was provided.ConclusionsDespite a thorough search, no studies could be found that met the inclusion criteria. All studies that compared either fEVAR or bEVAR with either OSR or no surgery explicitly selected patients based on prognosis, i.e. essentially the populations for each comparator were not the same. Despite not being able to conduct a CEA, we have provided detailed methods for the conduct if data becomes available.Future workWe recommend at least one clinical trial to provide an unbiased estimate of effect for fEVAR/bEVAR compared with OSR or no surgery. This trial should also collect data for a CEA.Study registrationThis study is registered as PROSPERO CRD42013006051.FundingThe National Institute for Health Research Health Technology Assessment programme.

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