A multicenter cost-effectiveness analysis of endovascular versus open surgical repair for abdominal aortic aneurysm: Cost-effectiveness of EVAR versus OSR

Derya Engin; İsmail Ağırbaş; Atilla Aral

doi:10.28982/josam.8501

Authors

Derya Engin Hacettepe University Hospitals, Cost Accounting Unit, Ankara, Türkiye https://orcid.org/0000-0002-2837-7550
İsmail Ağırbaş Ankara University, Faculty of Health Sciences, Department of Healthcare Management, Ankara, Türkiye https://orcid.org/0000-0002-1664-5159
Atilla Aral Ankara University, Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Türkiye https://orcid.org/0000-0001-7924-2819

DOI:

https://doi.org/10.28982/josam.8501

Keywords:

Abdominal Aortic Aneurysm, Cost-effectiveness analysis, Health economics, Quality of life

Abstract

Background/Aim: Abdominal aortic aneurysm carries substantial clinical and economic consequences, and the long-term economic value of the available repair strategies remains important for reimbursement decisions. This study evaluated the cost-effectiveness of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) for abdominal aortic aneurysm using actual hospital invoice data.

Methods: This retrospective multicenter study included 509 patients treated with EVAR or OSR at Ankara University and Hacettepe University Hospitals between 2011 and 2020. Cost data were derived from actual hospital invoices. Quality of life was assessed using the EQ-5D-3L questionnaire, HeartQoL, and a visual analog scale. Cost-effectiveness was evaluated using a Markov model, and a budget impact analysis was performed.

Results: The 1-year total cost was 58,732.38 TL ($8,386.24) for EVAR and 15,638.25 TL ($2,232.95) for OSR, while the corresponding lifetime costs were 132,726.00 TL ($18,951.65) and 21,906.23 TL ($3,127.94), respectively. The cost per quality-adjusted life-year (QALY) was 52,460.87 TL ($7,490.77) for EVAR and 13,777.50 TL ($1,967.26) for OSR. The incremental cost-effectiveness ratio was 118,892 TL ($16,976.33) per QALY gained, below the threshold of 181,611.00 TL ($25,931.83).

Conclusion: EVAR was a cost-effective alternative to OSR within the threshold used in this analysis.

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