Midterm Cost and Effectiveness of Thoracic Endovascular Aortic Repair Versus Open Repair

Karimi, Ashkan; Walker, Karen L.; Martin, Tomas D.; Hess, Philip J.; Klodell, Charles T.; Feezor, Robert J.; Beck, Adam W.; Beaver, Thomas M.

doi:10.1016/j.athoracsur.2011.10.016

Cited by 34 publications

(32 citation statements)

References 19 publications

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“…Some of these studies have shown TEVAR to be less expensive due to shorter hospital stays with lower complication rates (10,14), while others have shown no difference between open and endovascular repairs (3,7). One study has evaluated costs beyond the initial hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…One study has evaluated costs beyond the initial hospital stay. Karimi and colleagues evaluated their TAA cost data in a 57 patient, single center cohort for 2 years post-intervention (14). They found that in-hospital and at 2 years post-intervention, TEVAR was the more cost effective option.…”

Section: Discussionmentioning

confidence: 99%

“…The current medical and financial climate in health care necessitates attention to the cost effectiveness of our treatment practices in addition to standard postoperative outcomes. Several studies have demonstrated that TEVARs typically have in-hospital costs that are similar to or lower than open repair (3,6,7,10,11,14). However, many individuals presume that TEVARs generate higher costs through time due to more frequent reinterventions and more frequent surveillance chest CT scans (6,14).…”

Section: Introductionmentioning

confidence: 99%

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Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms

Gillen

Schaheen

Yount

et al. 2015

Journal of Vascular Surgery

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Objective For descending thoracic aortic aneurysms (TAAs), it is generally considered that endovascular stents (TEVARs) reduce operative morbidity and mortality compared to open surgical repair. However, long-term differences in patient survival have not been demonstrated, and an increased need for aortic reintervention has been observed. Many assume that TEVAR becomes less cost effective through time due to higher rates of reintervention and surveillance imaging. This study investigated mid-term outcomes and hospital costs of TEVAR compared with open TAA repair. Methods This was a retrospective, single institution review of elective thoracic aortic aneurysm repairs between 2005 and 2012. Patient demographics, operative outcomes, reintervention rates, and hospital costs were assessed. The literature was also reviewed to determine commonly observed complication and reintervention rates for TEVAR and open repair. Monte Carlo simulation was utilized to model and forecast hospital costs for TEVAR and open TAA repair up to 3 years post-intervention. Results Our cohort consisted of 131 TEVARs and 27 open repairs. TEVAR patients were significantly older (67.2 vs. 58.7, p=0.02) and trended towards a more severe comorbidity profile. Operative mortality for TEVAR and open repair was 5.3% and 3.7%, respectively (p=1.0). There was a trend towards more complications in the TEVAR group, although not statistically significant (all p>0.05). In-hospital costs were significantly greater in the TEVAR group ($52,008 vs. $37,172, p=0.001). However, cost modeling utilizing reported complication and reintervention rates from the literature overlaid with our cost data produced a higher cost for the open group in-hospital ($55,109 vs. $48,006) and at 3 years ($58,426 vs. $52,825). Interestingly, TEVAR hospital costs, not reintervention rates, were the most significant driver of cost in the TEVAR group. Conclusions Our institutional data showed a trend toward lower mortality and complication rates with open TAA repair, with significantly lower costs within this cohort compared to TEVAR. These findings were likely at least in part due to the milder comorbidity profile within these patients. In contrast, cost modeling using Monte Carlo simulation demonstrated lower costs with TEVAR compared to open repair at all time points up to 3 years post-intervention. Our institutional data shows that with appropriate patient selection, open repair can be performed safely with low complication rates comparable to TEVAR. The cost model argues that despite the costs associated with more frequent surveillance imaging and reinterventions, TEVAR remains the more cost effective option even years after TAA repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms

Gillen

Schaheen

Yount

et al. 2015

Journal of Vascular Surgery

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“…7 Exact secondary interventions performed to treat aortic aneurysm rupture were not available in evaluated studies. 18,20,21 Two reported ruptures were managed by endovascular procedures, 7,8 another by a hybrid procedure, 7 rupture rates in these studies were 2.4% 8 and 4.2%. 7 No data were available to assess if the risk of aneurysm rupture increases or decreases over time.…”

Section: Endograft-related Complicationsmentioning

confidence: 95%

A review of follow-up outcomes after elective endovascular repair of degenerative thoracic aortic aneurysms

et al. 2015

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Long-term outcomes of elective thoracic endovascular aortic repair (TEVAR) for degenerative thoracic aortic aneurysms (TAA) are not well defined. A review of the literature on the follow-up outcomes of elective TEVAR for degenerative TAA resulted in 22 relevant articles. Two- and five-year freedom from aneurysm-related death varied between 93.0% and 100.0%, and 82.4% to 92.7%, respectively. Two-year and five-year all-cause survival ranged between 68.0% and 97.2% and 47.0% to 78.0%, respectively. Follow-up ranged between 17.3 and 66.0 months. Most common endograft-related complication was endoleak, with reported rate between 1.4% and 14.8% during six months up to five years of follow-up. Endovascular reinterventions were reported in 0.0-32.3%, secondary open surgery was needed in 0.0% to 4.7% during follow-up. Aneurysm-related survival rates after elective TEVAR for degenerative TAA are acceptable. However, reported incidences of endograft-related complications vary considerably in the literature, but the majority can be managed with conservative treatment or additional endovascular procedures.

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“…Although minimally invasive techniques have increased in the last decade, there is still a role of open surgical repair for the following reasons: (a) the endosurgical instruments and devices are not available in all centers, (b) the number of skilled interventionists remains small, and (c) endosurgery is not necessarily more costeffective than surgical reconstructions. 2,3 Replacement by aortic graft has been the most widely used open surgical procedure for complicated acute type B aortic dissections. 4 Until 2008 the least invasive treatment of complicated acute type B aortic dissection was the open surgical suprarenal aortic fenestration in patients without rupture or impending rupture at the authors' institution.…”

Section: Introductionmentioning

confidence: 99%

Early and Long-term Outcome after Open Surgical Suprarenal Aortic Fenestration in Patients with Complicated Acute Type B Aortic Dissection

Szeberin

Dósa

Fehérvári

et al. 2015

European Journal of Vascular and Endovascular Surgery

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Midterm Cost and Effectiveness of Thoracic Endovascular Aortic Repair Versus Open Repair

Cited by 34 publications

References 19 publications

Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms

Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms

A review of follow-up outcomes after elective endovascular repair of degenerative thoracic aortic aneurysms

Early and Long-term Outcome after Open Surgical Suprarenal Aortic Fenestration in Patients with Complicated Acute Type B Aortic Dissection

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