Endovascular aortic repair is a cost-effective option for in-hospital patients with abdominal aortic aneurysm

To investigate the cost-effectiveness of endovascular aortic repair (EVAR) versus open aortic repair (OAR) for abdominal aortic aneurysm (AAA) using incremental costs per decreased in-hospital mortality rate gained through our patients' cohort. Medical records and healthcare costs of patients w...

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Published in:Journal of the Chinese Medical Association 2021-09, Vol.84 (9), p.890-899
Main Authors: Shih, Chia-Wen, Ho, Shung-Tai, Shui, Hao-Ai, Tang, Chi-Tun, Shih, Chun-Che, Chen, Tzeng-Ji, Lin, Kuan-Chia, Liang, Chun-Yu, Wang, Kwua-Yun
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Aged
Aortic Aneurysm, Abdominal - physiopathology
Aortic Aneurysm, Abdominal - surgery
Cost-Benefit Analysis
Endovascular Procedures - economics
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Taiwan - epidemiology
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cited_by cdi_FETCH-LOGICAL-c4014-ec346d48dabb4fc4f748621f9f49b651b809f39572ef0fd3ad74f281676affd63
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container_title Journal of the Chinese Medical Association
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creator Shih, Chia-Wen
Ho, Shung-Tai
Shui, Hao-Ai
Tang, Chi-Tun
Shih, Chun-Che
Chen, Tzeng-Ji
Lin, Kuan-Chia
Liang, Chun-Yu
Wang, Kwua-Yun
description To investigate the cost-effectiveness of endovascular aortic repair (EVAR) versus open aortic repair (OAR) for abdominal aortic aneurysm (AAA) using incremental costs per decreased in-hospital mortality rate gained through our patients' cohort. Medical records and healthcare costs of patients with AAA hospitalized between 2010 and 2015 were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Multiple regression analysis was applied to adjust for confounding factors and to compare the differences in postoperative clinical outcomes between patients who received EVAR and OAR. The incremental cost-effectiveness ratio (ICER) of EVAR was determined based on the healthcare cost obtained from the analyzed data. A total of 2803 AAA patients were identified (n = 559 with ruptured AAA and n = 2244 unruptured AAA). Patients with ruptured AAA who underwent EVAR compared with OAR patients had shorter hospital and intensive care unit (ICU) stays (all p < 0.05). For patients with unruptured AAA, those who received EVAR compared with OAR, the adjusted odds ratio (aOR) of postoperative complications and in-hospital mortality were 0.371 and 0.447 (all p < 0.05). The total direct surgical costs and medical expenses during hospitalization in all AAA patients were higher for the EVAR group; however, ICER was
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The total direct surgical costs and medical expenses during hospitalization in all AAA patients were higher for the EVAR group; however, ICER was &lt;1 per capita gross domestic product. Stratification by age groups further suggested that ICER for patients with unruptured AAA who received EVAR, compared with OAR, decreased with age. Total direct medical costs were higher for AAA patients receiving EVAR regardless of rupture status; however, the cost is offset by lower odds of postoperative complications and in-hospital mortality. The observed decrease in ICER with age and EVAR use warrants further analysis. Our findings further validate the use of EVAR over OAR. 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The total direct surgical costs and medical expenses during hospitalization in all AAA patients were higher for the EVAR group; however, ICER was &lt;1 per capita gross domestic product. Stratification by age groups further suggested that ICER for patients with unruptured AAA who received EVAR, compared with OAR, decreased with age. Total direct medical costs were higher for AAA patients receiving EVAR regardless of rupture status; however, the cost is offset by lower odds of postoperative complications and in-hospital mortality. The observed decrease in ICER with age and EVAR use warrants further analysis. Our findings further validate the use of EVAR over OAR. 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subjects Aged
Aortic Aneurysm, Abdominal - physiopathology
Aortic Aneurysm, Abdominal - surgery
Cost-Benefit Analysis
Endovascular Procedures - economics
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Taiwan - epidemiology
title Endovascular aortic repair is a cost-effective option for in-hospital patients with abdominal aortic aneurysm
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