Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms

Jacob R. Gillen, Basil W. Schaheen, Kenan W. Yount, Kenneth J. Cherry, John A. Kern, Irving L. Kron, Gilbert R. Upchurch, Christine L. Lau

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: For descending thoracic aortic aneurysms (TAAs), it is generally considered that thoracic endovascular aortic repairs (TEVARs) reduce operative morbidity and mortality compared with open surgical repair. However, long-term differences in survival of patients have not been demonstrated, and an increased need for aortic reintervention has been observed. Many assume that TEVAR becomes less cost-effective through time because of higher rates of reintervention and surveillance imaging. This study investigated midterm outcomes and hospital costs of TEVAR compared with open TAA repair. Methods: This was a retrospective, single-institution review of elective TAA repairs between 2005 and 2012. Patient demographics, operative outcomes, reintervention rates, and hospital costs were assessed. The literature was also reviewed to determine commonly observed complication and reintervention rates for TEVAR and open repair. Monte Carlo simulation was used to model and to forecast hospital costs for TEVAR and open TAA repair up to 3 years after intervention. Results: Our cohort consisted of 131 TEVARs and 27 open repairs. TEVAR patients were significantly older (67.2 vs 58.7 years old; P =.02) and trended toward a more severe comorbidity profile. Operative mortality for TEVAR and open repair was 5.3% and 3.7%, respectively (P = 1.0). There was a trend toward more complications in the TEVAR group, although not statistically significant (all P >.05). In-hospital costs were significantly greater in the TEVAR group ($52,008 vs $37,172; P =.001). However, cost modeling by use of reported complication and reintervention rates from the literature overlaid with our cost data produced a higher cost for the open group in-hospital ($55,109 vs $48,006) and at 3 years ($58,426 vs $52,825). Interestingly, TEVAR hospital costs, not reintervention rates, were the most significant driver of cost in the TEVAR group. Conclusions: Our institutional data showed a trend toward lower mortality and complication rates with open TAA repair, with significantly lower costs within this cohort compared with TEVAR. These findings were likely, at least in part, to be due to the milder comorbidity profile of these patients. In contrast, cost modeling by Monte Carlo simulation demonstrated lower costs with TEVAR compared with open repair at all time points up to 3 years after intervention. Our institutional data show that with appropriate selection of patients, open repair can be performed safely with low complication rates comparable to those of TEVAR. The cost model argues that despite the costs associated with more frequent surveillance imaging and reinterventions, TEVAR remains the more cost-effective option even years after TAA repair.

Original languageEnglish (US)
Pages (from-to)596-603
Number of pages8
JournalJournal of vascular surgery
Volume61
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Blood Vessel Prosthesis Implantation
Elective Surgical Procedures
Economic Models
Thoracic Aortic Aneurysm
Monte Carlo Method
Endovascular Procedures
Cost Savings
Hospital Costs
Reoperation
Computer Simulation
Cost-Benefit Analysis
Thorax
Retrospective Studies
Costs and Cost Analysis
Therapeutics
Mortality
Comorbidity

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Gillen, J. R., Schaheen, B. W., Yount, K. W., Cherry, K. J., Kern, J. A., Kron, I. L., ... Lau, C. L. (2015). Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms. Journal of vascular surgery, 61(3), 596-603. https://doi.org/10.1016/j.jvs.2014.09.009

Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms. / Gillen, Jacob R.; Schaheen, Basil W.; Yount, Kenan W.; Cherry, Kenneth J.; Kern, John A.; Kron, Irving L.; Upchurch, Gilbert R.; Lau, Christine L.

In: Journal of vascular surgery, Vol. 61, No. 3, 01.03.2015, p. 596-603.

Research output: Contribution to journalArticle

Gillen, JR, Schaheen, BW, Yount, KW, Cherry, KJ, Kern, JA, Kron, IL, Upchurch, GR & Lau, CL 2015, 'Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms', Journal of vascular surgery, vol. 61, no. 3, pp. 596-603. https://doi.org/10.1016/j.jvs.2014.09.009
Gillen, Jacob R. ; Schaheen, Basil W. ; Yount, Kenan W. ; Cherry, Kenneth J. ; Kern, John A. ; Kron, Irving L. ; Upchurch, Gilbert R. ; Lau, Christine L. / Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms. In: Journal of vascular surgery. 2015 ; Vol. 61, No. 3. pp. 596-603.
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AU - Gillen, Jacob R.

AU - Schaheen, Basil W.

AU - Yount, Kenan W.

AU - Cherry, Kenneth J.

AU - Kern, John A.

AU - Kron, Irving L.

AU - Upchurch, Gilbert R.

AU - Lau, Christine L.

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N2 - Objective: For descending thoracic aortic aneurysms (TAAs), it is generally considered that thoracic endovascular aortic repairs (TEVARs) reduce operative morbidity and mortality compared with open surgical repair. However, long-term differences in survival of patients have not been demonstrated, and an increased need for aortic reintervention has been observed. Many assume that TEVAR becomes less cost-effective through time because of higher rates of reintervention and surveillance imaging. This study investigated midterm outcomes and hospital costs of TEVAR compared with open TAA repair. Methods: This was a retrospective, single-institution review of elective TAA repairs between 2005 and 2012. Patient demographics, operative outcomes, reintervention rates, and hospital costs were assessed. The literature was also reviewed to determine commonly observed complication and reintervention rates for TEVAR and open repair. Monte Carlo simulation was used to model and to forecast hospital costs for TEVAR and open TAA repair up to 3 years after intervention. Results: Our cohort consisted of 131 TEVARs and 27 open repairs. TEVAR patients were significantly older (67.2 vs 58.7 years old; P =.02) and trended toward a more severe comorbidity profile. Operative mortality for TEVAR and open repair was 5.3% and 3.7%, respectively (P = 1.0). There was a trend toward more complications in the TEVAR group, although not statistically significant (all P >.05). In-hospital costs were significantly greater in the TEVAR group ($52,008 vs $37,172; P =.001). However, cost modeling by use of reported complication and reintervention rates from the literature overlaid with our cost data produced a higher cost for the open group in-hospital ($55,109 vs $48,006) and at 3 years ($58,426 vs $52,825). Interestingly, TEVAR hospital costs, not reintervention rates, were the most significant driver of cost in the TEVAR group. Conclusions: Our institutional data showed a trend toward lower mortality and complication rates with open TAA repair, with significantly lower costs within this cohort compared with TEVAR. These findings were likely, at least in part, to be due to the milder comorbidity profile of these patients. In contrast, cost modeling by Monte Carlo simulation demonstrated lower costs with TEVAR compared with open repair at all time points up to 3 years after intervention. Our institutional data show that with appropriate selection of patients, open repair can be performed safely with low complication rates comparable to those of TEVAR. The cost model argues that despite the costs associated with more frequent surveillance imaging and reinterventions, TEVAR remains the more cost-effective option even years after TAA repair.

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