CHICAGO - A recent study, published in the August issue of the Journal of Vascular SurgeryTM, compared the resource use, medical cost, and quality of life outcomes for treatment strategies involving early endovascular repair (EVAR) vs. surveillance with serial imaging studies for treatment of small (4.0 to 5.0 cm diameter) abdominal aortic aneurysms (AAAs). Researchers reported no difference in medical costs between the treatment strategies at 48 months and no difference in quality of life outcomes at 24 months. The study was part of the Positive Impact of endoVascular Options for Treating Aneurysms earLy (PIVOTAL) randomized trial which reported no difference in rupture or aneurysm-related death for patients who received early EVAR vs. surveillance with serial imaging studies.
Eric L. Eisenstein, DBA, associate professor in medicine at Duke Clinical Research Institute, Durham, NC, said that 67 PIVOTAL sites participated in the quality of life and 63 participated in the economic studies. The trial randomized 728 patients (366 early EVAR and 362 surveillance).
“We used information from 701 quality of life (351 early EVAR and 350 surveillance) and 614 economic (314 early EVAR and 300 surveillance) study participants enrolled in the PIVOTAL trial,” said Dr. Eisenstein.
Researchers noted that after six months, the rate of aneurysm repair was 96 vs. 10 per 100 patients in the early EVAR and surveillance groups, respectively (difference, 86; a 95 percent conﬁdence interval [CI], 82-90; P < .0001). Total medical costs were greater in the early EVAR group ($33,471 vs. $5,520 (difference, $27,951; 95 percent CI, $25,156-$30,746; P < .0001).
Dr. Eisenstein added that in months seven 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 vs. the early EVAR group ($40,592 vs. $15,197; difference, $25,394; 95 percent CI, $15,184-$35,605; P < .0001).
However at 48 months’ follow-up, early EVAR patients had greater cumulative use
of AAA repair (97 vs. 64 per 100 patients; difference, 34; 95 percent CI, 21-46;
P < .0001), but there was no difference in total medical costs ($48,669 vs. $46,112; difference, $2,557; 95 percent CI, -$8,04 to $13,156; P=.64). After discounting at 3 percent annum, total medical costs for early EVAR and surveillance patients remained similar ($47,765 vs. $43,532; difference, $4,232; 95 percent CI, -$5,561 to $14,025; P=.40).
“Longer follow-up is required to determine whether the late medical cost increases observed for surveillance will persist beyond 48 months,” said Dr.Eisenstein.
About Journal of Vascular Surgery®
Journal of Vascular Surgery® provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal’s sponsoring society, the Society for Vascular Surgery®. Visit the Journal Web site at http://www.jvascsurg.org/.
About the Society for Vascular Surgery
The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 4,500 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. Visit its Web site at www.VascularWeb.org®.