Cost and Quality-of-Life Data Compared for Early EVAR and Surveillance of Small AAAs

August 6, 2013—The Society for Vascular Surgery (SVS) announced publication of a study that compared the resource use, medical cost, and quality of life (QOL) outcomes for treatment strategies involving early endovascular repair (EVAR) versus surveillance with serial imaging studies for treatment of small (4–5 cm in diameter) abdominal aortic aneurysms (AAAs). The investigators reported no difference in medical costs between the treatment strategies at 48 months and no difference in QOL outcomes at 24 months. Eric L. Eisenstein, DBA, et al published the study in Journal of Vascular Surgery (2013;58:302–310).

According to the SVS release, the study was part of the PIVOTAL (Positive Impact of Endovascular Options for Treating Aneurysms Early) randomized trial, which reported no difference in rupture or aneurysm-related death for patients who received early EVAR versus surveillance with serial imaging studies. Kenneth Ouriel, MD, served as Principal Investigator of PIVOTAL.

In the SVS press release, Dr. Eisenstein, who is associate professor in medicine at Duke Clinical Research Institute, Durham, North Carolina, advised that 67 PIVOTAL sites participated in the QOL study and 63 participated in the economic study. The trial randomized 728 patients (366 early EVAR and 362 surveillance). He commented, “We used information from 701 QOL (351 early-EVAR and 350 surveillance) and 614 economic (314 early-EVAR and 300 surveillance) study participants enrolled in the PIVOTAL trial.”

According to the SVS, the investigators noted that after 6 months, the rate of aneurysm repair was 96 versus 10 per 100 patients in the early-EVAR and surveillance groups, respectively (difference, 86; 95% confidence interval [CI], 82 to 90; P < .0001). Total medical costs were greater in the early-EVAR group ($33,471 vs $5,520; difference, $27,951; 95% CI, $25,156 to $30,746; P < .0001).

Dr. Eisenstein added that in months 7 through 48, the rate of aneurysm repair was 54 per 100 patients in the surveillance group, and total medical costs were higher for patients in the surveillance versus the early-EVAR group ($40,592 vs $15,197; difference, $25,394; 95% CI, $15,184 to $35,605; P < .0001).

However at 48-month follow-up, early EVAR patients had greater cumulative use of AAA repair (97 vs 64 per 100 patients; difference, 34; 95% CI, 21 to 46; P < .0001), but there was no difference in total medical costs ($48,669 vs $46,112; difference, $2,557; 95% CI, -$8,043 to $13,156; P = .64). After discounting at 3% per annum, total medical costs for early EVAR and surveillance patients remained similar ($47,765 vs $43,532; difference, $4,232; 95% CI, -$5,561 to $14,025; P = .4).

“Longer follow-up is required to determine whether the late medical cost increases observed for surveillance will persist beyond 48 months,” stated Dr. Eisenstein in the SVS press release.