Quality-adjusted life year comparison at medium term follow-up of endovascular versus open surgical repair for abdominal aortic aneurysm in young patients

Abstract

Objectives This study aimed to compare the quality of life and cost effectiveness between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in young patients with abdominal aortic aneurysm (AAA). Design This was a single-center, observational, and retrospective study. Materials and methods A retrospective analysis was conducted of patients with AAA, who were <70 years old and underwent EVAR or OSR between January 2012 and October 2016. Only patients with aortic morphology that was suitable for EVAR were enrolled. Data on the complication rates, medical expenses, and expected quality-adjusted life years (QALYs) were collected, and the cost per QALY at three years was compared. Results Among 90 patients with aortic morphology who were eligible for EVAR, 37 and 53 patients underwent EVAR and OSR, respectively. No significant differences were observed in perioperative cardiovascular events and death between the two groups. However, during the follow-up period, patients undergoing OSR showed a significantly lower complication rate (hazard ratio [HR] = 0.11; P = .021). From the three-year cost-effectiveness analysis, the total sum of costs was significantly lower in the OSR group (P < .001) than that in the EVAR group, and the number of QALYs was superior in the OSR group (P = .013). The cost per QALY at three years was significantly lower in the OSR group than that in the EVAR group (mean: $4038 vs. $10 137; respectively; P < .001) Conclusions OSR had lower complication rates and better cost-effectiveness than EVAR Among young patients with feasible aortic anatomy.

Treatment of abdominal aortic aneurysms in Korea: a nationwide study

“…The initial procedure costs of OSR and EVAR for AAA repair in Korea were USD 1,387 and USD 1,284, respectively. A previous study based on the Korean population reported, however, that the in-hospital cost of EVAR in patients aged <70 years was more than twice that of OSR [ 16 ], suggesting that the similar in-hospital cost in the 2 groups was likely due to the increased cost of treatment of patients aged >70 years. During the study period, AAA-related reinterventions per 100 PY were more than 3-fold higher in the EVAR group, even after adjusting for the reduction in reintervention rate due to the higher early mortality rate of the OSR group and between-group differences in follow-up periods.…”