Health care costs of endovascular compared with open thoracoabdominal aortic aneurysm repair
Rocha RV, de Mestral C, Tam DY, Lee DS, Al-Omran M, Austin PC, Forbes TL, Ouzounian M, Lindsay TF. J Vasc Surg. 2021; 23(6):1934-41.e1. Epub 2020 Oct 20. DOI: https://doi.org/10.1016/j.jvs.2020.09.034
Objective — To compare 1-year health care costs of open and endovascular thoracoabdominal aortic aneurysm (TAAA).
Methods — Population-based administrative health databases were used to capture TAAA repairs performed in Ontario, Canada, between January 2006 and March 2017. All health care costs incurred by the Ministry of Health were included. Costs of the aortic endografts and devices for the index procedure were C$44,000 per case versus C$1000 for open cases. Costs (2017 Canadian $) were calculated in phases (1, 1-3, 3-6, 6-12 months) with censoring for death. Propensity score matching based on 26 preoperative characteristics was used. The association between preoperative characteristics and 1-month cost were characterized through multivariable analysis.
Results — Overall 664 TAAA repairs were identified (open, n = 361 [54.5%] and endovascular, n = 303 [45.6%]) and 241 open/endovascular propensity score-matched pairs were formed. At 1 month, the mean [median] total cost for the pre propensity score matched open TAAA group was C$46,575 [C$36,647] (77% hospital cost, 14% physician billings, 3% graft cost, 6% other), whereas for the endovascular group, total cost was C$72,581 [C$64,892] (67% graft cost, 27% hospital cost, 5% physician billings, 1% other; P < .01). At 1 to 3 months, 3 to 6 months, and 6 months to 1 year postprocedure intervals, there were no significant difference in health care costs between groups (Table). The mean [median] cumulative cost for patients alive at 1-year were C$91,571 [C$52,003] versus C$103,740 [C$83,242]; P < .01 for open (n = 264) and endovascular (n = 206) TAAA repair, respectively. On multivariable analysis, older age (P < .01), nonelective procedures (P < .01), and preoperative stroke (P = .05) were associated with increased costs at 1 month.
Conclusions — While devices led to higher 1-month costs of endovascular TAAA repair, total cumulative health care costs after the first month and up to 1 year were not significantly different, including re-interventions. Higher 1-month costs occurred with older age, preoperative stroke, and nonelective procedures.