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Costs of Repair of Abdominal Aortic Aneurysm with Different Devices: Results of a Multicenter Randomized Trial
Jon Matsumura1, Kevin Stroupe2, Frank Lederle3, Tassos Kyriakides4, Julie Freischlag5
1University of Wisconsin, Madison, WI;2VA Information Resource Center, Hines, IL;3Minneapolis VA Health Care, Minneapolis, MN;4Yale, New Haven, CT;5John Hopkins, Baltimore, MD

Objective. Prior analysis has demonstrated that survival, quality of life, and total healthcare costs are not significantly different between the two methods of repair of abdominal aortic aneurysm (AAA) in the Open Versus Endovascular Repair Veterans Affairs (VA) Cooperative Study. The device is a substantial portion of the cost of this method of repair, and the objective of this study is to evaluate the costs of AAA repair and total healthcare costs when different endograft systems are selected for the endovascular repair.
Methods. Eight hundred and eighty-one subjects were randomized to open (437) or endovascular repair (444). Device selection was recorded before randomization; therefore open repair controls are matched to each device cohort. Data was excluded for two low volume devices, implanted in only 13 subjects. Mean device, hospitalization, and total healthcare costs from randomization to two years were compared. Health care utilization data were obtained from patients and national VA and Medicare data sources. VA costs were determined using methods previously developed by the VA Health Economics Resource Center. Non-VA costs were obtained from Medicare claims data and billing data from the patientís healthcare providers.
Results. Implant costs are 38% of initial hospitalization costs. Mean device, initial hospitalization and total health care costs at two years in the endovascular and open repair groups are not significantly different between device systems. Differences between endovascular and corresponding open repair cohorts show lower mean costs for endovascular repair but these are not statistically different.

EVR Device (n-=431)
Mean Costs 0SD)
Excluder (n=177) AneuRx
Implant 14,395 (2552) 13,582 (3820) 14,262 (4191) 0.08
Initial Hospitalization 38,141 (27517) 34,804 (31206) 38,942 (24874) 0.43
Total at 2 years 78,198 (60216) 73,458 (65123) 72,438 (42389) 0.68
Open Repair (n=423) (n=175) (n=150) (n=98)  
Total at 2 years 82,069 (113783) 81,791 (84488) 75,591 (84061) 0.85
P-value:EVR vs Open 0.69 0.33 0.74  

Conclusions. Endovascular aneurysm repair implant costs are substantial. When evaluating total healthcare system expenditures, there is large individual variability in costs, and there is no significant difference at two years between systems or when an individual system is compared to open repair.

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