Veterans Affairs Study Compares Cost Effectiveness of EVAR Versus Open Repair

May 28, 2012—Kevin T. Stroupe, PhD, et al conducted a study to determine the costs and comparative cost effectiveness of two methods of abdominal aortic aneurysm (AAA) repair in the Open Versus Endovascular Repair Veterans Affairs (VA) Cooperative Study, a multicenter randomized trial that was composed of 881 patients. The investigators published their findings online ahead of print in the Journal of Vascular Surgery.

As summarized in the Journal of Vascular Surgery, the primary outcomes of this analysis were mean total health care cost per life-year and per quality-adjusted life-year (QALY) from randomization to 2 years after treatment. QALYs were calculated from EuroQoL-5D questionnaires collected at baseline and annually. Health care utilization data were obtained directly from patients and from national VA and Medicare data sources. VA costs were obtained from national VA sources using methods previously developed by the VA Health Economics Resource Center. Costs for non-VA care were determined from Medicare claims data or billing data from the patients’ health care providers.

The investigators reported that after 2 years of follow-up, mean life-years were 1.78 in the endovascular repair group and 1.74 in the open repair group (difference, 0.04; 95% confidence interval [CI], -0.03–0.09; P = .29). Mean QALYs were 1.462 in the endovascular group and 1.461 in the open group (difference adjusting for baseline EuroQoL-5D score, 0.006; 95% CI, -0.038–0.052; P = .78). Mean graft costs were higher in the endovascular group ($14,052 vs $1,363; P < .001), but length of stay was shorter (5 vs 10.5 days; P < .001), resulting in a lower mean cost of hospital admission for the AAA procedure in the endovascular repair group of $37,068 versus $42,970 (difference, -$5,901; 95% CI, -$12,135 to -$821; P = .04).

The investigators found that after 2 years, total health care costs remained lower in the endovascular group, but the difference was no longer significant (-$5,019; 95% CI, -$16,720–$4,928; P = .35). The probability of endovascular repair being less costly and more effective was 70.9% for life-years and 51.4% for QALYs.

In this multicenter randomized trial, endovascular AAA repair resulted in lower costs and better survival than open repair after the initial hospitalization for repair. But, after 2 years, survival, quality of life, and costs were not significantly different between the two treatments, concluded the investigators in the Journal of Vascular Surgery.