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Home > Vascular Annual Meeting^® > PVSS2. Cost-Effectiveness of Abdominal Aortic Aneurysm...

PVSS2. Cost-Effectiveness of Abdominal Aortic Aneurysm Repair Based on Aneurysm Size

Kate C. Young, PhD, MPH; Nadia A. Awad, BS; Marcia Johansson, NP; David Gillespie, MD; Michael Singh, MD; Karl Illig, MD
Univ of Rochester, Rochester, NY

OBJECTIVES: To model the cost-effectiveness of endovascular repair (EVAR) for small abdominal aortic aneurysms (AAA).

METHODS: We developed a Markov model of a hypothetical 65-year old cohort to determine the cost-effectiveness of early EVAR for small AAAs (4.0-5.4 cm) compared to traditional repair at 5.5 cm. Repair options include both endovascular and open procedures. Probabilities were obtained from the literature. Costs reflected direct costs in 2007 dollars. Outcomes were measured as quality adjusted life years (QALYs).

RESULTS: The model demonstrated that observational management with early EVAR for 4.0-5.2 cm AAAs produced fewer QALYs at greater costs when compared to elective repair at 5.5 cm. It also showed that observational management and repair at 5.5 cm produced the same costs and outcomes as EVAR of 5.3-5.5 cm AAAs. Sensitivity analyses suggested that early EVAR can be cost-effective under certain conditions. If the long-term mortality rate after EVAR is ≤2.5% per year or the quality of life after EVAR is improved, early EVAR for AAAs ≥4.6 cm is warranted. Likewise, if the quality of life before repair is low, EVAR for AAAs ≥4.0 cm may be cost-effective.

CONCLUSIONS: Markov modeling for early EVAR for AAAs <5.5 cm is not cost-effective compared to elective repair at 5.5 cm. From a cost-effective and public policy standpoint, this analysis supports observational management of small AAAs until 5.5 cm. However, EVAR for small AAAs may be cost-effective when differences in quality of life, rupture risk and mortality are considered.

AUTHOR DISCLOSURES: K.C. Young, None; N.A. Awad, None, M. Johansson, None; D. Gillespie, None; M. Singh, None; K. Illig, None.