Cost Comparison of Aortic Aneurysm Endograft Exclusion Versus Open Surgical Repair

Background: Shrinking health care resources impose a requirement to evaluate new technology for cost as well as clinical effectiveness. We studied an initial clinical experience with endograft treatment (EAG) of abdominal aortic aneurysm (AAA) at the beginning of an endovascular program in comparison with open surgical repair (OSR), which had been in use for decades.

Methods: From March 1997 to April 1998, the utilization of hospital resources, actual cost, clinical descriptors, and treatment outcomes were recorded for two contemporaneous groups, each having 16 consecutive patients with AAA, treated with either EAG or OSR. Subjects were not randomized; EAG treatment was based on predetermined exclusion/inclusion criteria. Statistical comparison was by either Fisher's exact test or the Wilcoxon rank sum test.

Results: There were no differences between OSR and EAG in age, gender, AAA size, smoking status, diabetes, ischemic heart disease, history of coronary artery bypass grafts, previous vascular surgery, or other comorbidity. There were no deaths in either group. Patients treated by EAG procedure had significantly lower length of hospital stay, length of stay in intensive care unit, time in operating room, and cost of operating room without graft (P <0.05). Cost of operating room with graft was less in OSR group (P <0.001). In-hospital imaging costs specific to the EAG procedure were $1,370.45 +/- $66.92 (range $911.58 to $1,826.76). Total costs were not significantly different between the OSR and EAG, $12,714.19 +/- $1,115.52 and $12,904.99 +/- $494.69, respectively (P = 0.26).

Conclusions: Total hospital cost is not different for the two treatments studied despite differences in experience with their use. Endograft treatment utilizes significantly less hospital resources than open surgical repair. The endograft prosthesis contributes a significant cost increment that may decline with expanded use.