IP055 - Cost-Effectiveness and Short-Term Benefits of Endovascular Aortic Repair vs. Open Surgical Repair for Ruptured Abdominal Aortic Aneurysms

Objectives: Ruptured abdominal aortic aneurysms (rAAA) can be treated via an endovascular aneurysm repair (EVAR) or open surgical repair (OSR). Based on recent Society for Vascular Surgery guidelines, EVAR has become the recommended approach for rAAA, however, there is relatively little data regarding the cost-effectiveness. We hypothesized that EVAR would be less cost-effective due to device cost but being minimally invasive, would have better outcomes compared to OSR.

Methods: An IRB approved retrospective chart review was performed on patients with an rAAA who underwent EVAR or OSR procedures at Thomas Jefferson University Hospital between 2010-2020. The Medical Records, as well as Healthcare Account Records, were queried to retrieve data and costs. ANOVA and Chi-square analyses comparing EVAR and OSR procedures were performed.

Results: Among 53 patients with rAAA, 38 underwent EVAR and 15 underwent OSR (71.7% vs 28.3%, respectively). Within this cohort, 62.5% of females and 73.3% of males underwent EVAR. Overall, 25 (47.2%) patients died within 30-days, while 13 (24.5%) patients died within 24 hours of presentation. OSR had more 30-day postoperative mortalities compared to EVAR (53.3% vs 20%, p = .0018).
The median length of hospital stays for OSR was 13.25 days and 9.78 days for EVAR. When compared to EVAR, the OSR cohort had a higher average cost for their intensive care unit (ICU) stay ($23,377.18 vs $7,182.87, p = .0063). While not statistically significant, there is a trend for operative costs of EVAR to be more expensive than OSR due to the increased average graft cost ($18,339.17 vs $5.733.95, p = .053). The average total hospital cost was comparable between patients undergoing OSR and EVAR with a trend for increased hospital costs for the OSR group ($52,896.89 vs $46,345.72 respectively, p = .29).

Conclusions: The statistical trends show EVAR to be a cost-effective option in addition to having lower decreased 30-day mortality. The increased operative costs for EVAR were offset by lower costs for hospital admission due to shorter ICU stays. Further analysis of long-term follow up will need to be performed to determine the longitudinal costs of each repair type.