Study Suggests Cost Equivalence of Elective EVAR and Open Repair of AAA

December 1, 2020—A systemic evaluation of the costs of elective endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA) in the Netherlands found that for most routine repairs, EVAR is not costlier than OR until at least the 5-year follow-up. 

The study findings were published by Ruth M.A. Bulder, MD, et al in European Journal of Vascular and Endovascular Surgery (EJVES; 2020;60:655-662). Jan H.N. Lindeman, MD, from the Department of Vascular Surgery at Leiden University Medical Center in Leiden, the Netherlands was the senior investigator of the study.

The background of study, noted in the EJVES abstract, is, “The suggested high costs of EVAR hamper the choice of insurance companies and financial regulators for EVAR as the primary option for elective AAA repair. However, arguments used in this debate are impeded by time-related aspects such as effect modification and the introduction of confounding by indication, and by asymmetric evaluation of outcomes. Therefore, a re-evaluation minimizing the impact of these interferences was considered.”

As summarized in the EJVES abstract, the comparative analysis included patients treated in a period of exclusive OR (1998-2000; n = 186) and a period of established EVAR (2010-2012; n = 195). Data from four hospitals in the Netherlands were collected to estimate resource use. Actual costs were estimated by benchmark cost prices and a literature review. The investigators reported costs at 2019 prices. A breakeven approach—defining the costs for an endovascular device at which cost equivalence for EVAR and OR is achieved—was applied to cope with the large variation in endovascular device costs.

Cost equivalence for OR and EVAR was reached at a break-even price for an endovascular device of €13,190. The main cost difference reflected the longer duration of hospital stay (ward and intensive care unit) of OR (€11,644). Reintervention rates were similar for OR and EVAR (24.2% vs 24.6%; P = .92), reported the investigators in EJVES.