December 28, 2014
OVER Trial Analysis Evaluates EVAR Costs With Different Devices
December 29, 2014—In the Journal of Vascular Surgery, Jon S. Matsumura, MD, et al published findings from an evaluation of the costs of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) with different devices in a multicenter, randomized trial (2015;61:59–65).
According to the investigators, previous analysis in the OVER (Open Versus Endovascular Repair) study demonstrated that survival, quality of life, and total health care costs are not significantly different between open and endovascular repair of AAA. In May 2012, Endovascular Today reported the publication of the OVER study in the Journal of Vascular Surgery (2012;56:901–909).
The investigators noted that the device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, AAA repair, and total health care costs when different endograft systems are selected for EVAR. Within each selected system, EVAR costs are compared with open repair costs.
As summarized in the Journal of Vascular Surgery, the study randomized 881 patients to open repair (n = 437) or EVAR (n = 444). Device selection was recorded before randomization, so open repair controls were matched to each device cohort. Data were excluded for two low-volume devices, implanted in only 13 patients, so there were 423 control and 431 endovascular patients, who were treated with: 166 Zenith (Cook Medical), 177 Excluder (Gore & Associates), and 88 AneuRx (Medtronic, Inc.).
Mean device, hospitalization, and total health care costs from randomization to 2 years were compared. Health care utilization data were obtained from patients and national VA and Medicare data sources. VA costs were determined using methods previously developed by the VA Health Economics Resource Center. Non-VA costs were obtained from Medicare claims data and billing data from the patient's health care providers.
The investigators reported that implant costs were 38% of initial hospitalization costs. Mean device (range, $13,600–$14,400), initial hospitalization (range, $34,800–$38,900), and total health care costs at 2 years in the endovascular (range, $72,400–$78,200) and open repair groups (range, $75,600–$82,100) were not significantly different among device systems. Differences between endovascular and corresponding open repair cohorts showed lower mean costs for EVAR (range, $3,200–$8,300), but these were not statistically different.
The implant costs of EVAR are substantial, and when evaluating total health care system expenditures, there is large individual variability in costs, and there is no significant difference at 2 years among the systems studied, or when an individual system is compared with open repair, concluded the investigators in Journal of Vascular Surgery.