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Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial

Elsevier BV; Volume: 61; Issue: 1 Linguagem: Inglês

10.1016/j.jvs.2014.08.003

1097-6809

Jon S. Matsumura, Kevin T. Stroupe, Frank A. Lederle, Tassos C. Kyriakides, Ling Ge, Julie A. Freischlag, Erika R. Ketteler, Darra D. Kingsley, John Marek, Richard J. Massen, Brian Matteson, John D. Pitcher, Mark Langsfeld, John D. Corson, James M. Goff, Karthnik Kasirajan, Christina Paap, Diane C. Robertson, Atef A. Salam, Ravi Veeraswamy, Ross Milner, Karthikeshwar Kasirajan, Jane Guidot, Brajesh K. Lal, Steven J. Busuttil, Michael Lilly, Melita Braganza, Kea Ellis, Mark A. Patterson, William D. Jordan, David Whitley, Steve M. Taylor, Marc A. Passman, Donna Kerns, Cindy Inman, Jennifer Poirier, James L. Ebaugh, J.D. Raffetto, David K. Chew, Subhash Lathi, Christopher Owens, Kathleen Hickson, Hasan H. Dosluoglu, Karen Eschberger, Melina R. Kibbe, Henry Baraniewski, Jon Matsumura, Michelle Endo, Anna Busman, Wendy Meadows, Mary E. Evans, Joseph S. Giglia, Hosam El Sayed, Amy B. Reed, Madeline Ruf, Stephanie Ross, Jessie Jean-Claude, Gilles Pinault, Preet Kang, Nadine E White, Matthew Eiseman, Reba Jones, Carlos H. Timaran, J. Gregory Modrall, M. Burress Welborn, J.Alonso Lopez, Tammy Nguyen, John K.Y. Chacko, Kenneth Granke, Angela G. Vouyouka, Erin Olgren, Prakash Chand, Brenda Allende, Michael J. Ranella, Claudia Yales, Thomas A. Whitehill, William C. Krupski, Mark R. Nehler, Stephen Johnson, Darrell N. Jones, Pamela K. Strecker, Michelle A. Bhola, Cynthia K. Shortell, John Gray, Jeffrey H. Lawson, Richard L. McCann, Mark Sebastian, Jean Kistler Tetterton, Carla Blackwell, Patricia A. Prinzo, Nina Lee, Frank T. Padberg, Joaquim J. Cerveira, Brajesh K. Lal, Robert W. Zickler, Karen Hauck, Scott A. Berceli, W. Anthony Lee, C. Keith Ozaki, Peter R. Nelson, Anne S. Irwin, Randy Baum, Bernadette Aulivola, Heron E. Rodríguez, Fred N. Littooy, Howard P. Greisler, Mary T. O'Sullivan, Panagiotis Kougias, Peter H. Lin, Ruth L. Bush, Gene Guinn, Catherine Cagiannos, Sherilyn Pillack, Barbara Guillory, Dolores F. Cikrit, Stephen G. Lalka, Gary W. Lemmon, Ryan Nachreiner, Mitzi Rusomaroff, Elaine O’Brien, Joseph J. Cullen, Jamal J. Hoballah, William J. Sharp, Jeanne L. McCandless, Vickie Beach, David J. Minion, Thomas H. Schwarcz, Joy Kimbrough, Laura Ashe, Anna K. Rockich, Jill Warner-Carpenter, Mohammed Moursi, John F. Eidt, Sandra Brock, Christian Bianchi, Vicki Bishop, Ian L. Gordon, Roy M. Fujitani, Stephen M. Kubaska, Mina Behdad, R. Azadegan, Christine Ma Agas, Kathy Zalecki, John R. Hoch, Sandra C. Carr, Charles W. Acher, Margaret L. Schwarze, Girma Tefera, Matthew W. Mell, Beth Dunlap, Janice Rieder, John Stuart, Darryl S. Weiman, Omran Abul-Khoudoud, H. Edward Garrett, Sandra Walsh, Karen L. Wilson, Gary R. Seabrook, Robert A. Cambria, Kellie R. Brown, Brian D. Lewis, Susan Framberg, Christa Kallio, Roderick A. Barke, Steven M. Santilli, Alexandre C. d’Audiffret, Nancy Oberle, Catherine Proebstle, Lauri Lee Johnson, Glenn R. Jacobowitz, Neal S. Cayne, Caron Rockman, Mark A. Adelman, Paul J. Gagne, Matthew M. Nalbandian, Leah J. Caropolo, Iraklis I. Pipinos, Jason M. Johanning, Thomas G. Lynch, Holly DeSpiegelaere, Georgia Purviance, Wei Zhou, Ronald L. Dalman, Jason T. Lee, Bassem Safadi, Sheila M. Coogan, Sherry M. Wren, Doghdoo D. Bahmani, Deanna Maples, Shawna Thunen, Michael A. Golden, Marc Mitchell, Ronald M. Fairman, Sally Reinhardt, Mark A. Wilson, Edith Tzeng, Satish C. Muluk, Nina Peterson, Maria Foster, James M. Edwards, Gregory L. Moneta, Gregory J. Landry, Lloyd M. Taylor, Richard Yeager, Eleanor Cannady, Gerald S. Treiman, Stephanie Hatton-Ward, Barbara Salabsky, Nikhil Kansal, Erik L. Owens, Melanie Estes, Beth A. Forbes, Cinda Sobotta, Joseph H. Rapp, Linda M. Reilly, Sandra L. Perez, Kimberly Yan, Rajaabrata Sarkar, Shelley Dwyer, Ted R. Kohler, Thomas S. Hatsukami, David G. Glickerman, Michael E. Sobel, Thomas S. Burdick, Kimberly Pedersen, Patricia A. Cleary, Nikhil Kansal, Erik L. Owens, Melanie Estes, Beth A. Forbes, Cinda Sobotta, Martin R. Back, Dennis F. Bandyk, Brad Johnson, Murray L. Shames, Rebecca L. Reinhard, Sandra C. Thomas, Glenn C. Hunter, Luis R. Leon, Alex Westerband, Robert J. Guerra, Macario Riveros, John L. Mills, John Hughes, Andréa M. Escalante, Shemuel B. Psalms, Nancy N. Day, Robyn Macsata, Anton N. Sidawy, Jonathan Weiswasser, Subodh Arora, Brenda J. Jasper, Alan Dardik, Vivian Gahtan, Bart E. Muhs, Bauer E. Sumpio, Richard J. Gusberg, Marcelo Spector, Jeffrey Pollak, John Aruny, Eamon Kelly, James Wong, Penny Vasilas, Carmelene Joncas, Hugh A. Gelabert, Christian DeVirgillio, David A. Rigberg, L R Cole,

Vascular Procedures and Complications

Prior analysis in the Open vs Endovascular Repair Veterans Affairs (VA) Cooperative Study (CSP #498) demonstrated that survival, quality of life, and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm. The device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, abdominal aortic aneurysm repair, and total health care costs when different endograft systems are selected for the endovascular repair (EVR). Within each selected system, EVR costs are compared with open repair costs.The study randomized 881 patients to open (n = 437) or EVR (n = 444). Device selection was recorded before randomization; therefore, open repair controls were matched to each device cohort. Data were excluded for two low-volume devices, implanted in only 13 individuals, leaving 423 control and 431 endovascular patients: 166 Zenith (Cook Medical, Bloomington, Ind), 177 Excluder (W. L. Gore & Associates, Flagstaff, Ariz), and 88 AneuRx (Medtronic, Minneapolis, Minn). Mean device, hospitalization, and total health care costs from randomization to 2 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 patient's health care providers.Implant costs were 38% of initial hospitalization costs. Mean device (range, $13,600-$14,400), initial hospitalization (range, $34,800-$38,900), and total health care costs at 2 years in the endovascular (range, $72,400-$78,200) and open repair groups (range, $75,600-$82,100) were not significantly different among device systems. Differences between endovascular and corresponding open repair cohorts showed lower mean costs for EVR (range, $3200-$8300), but these were not statistically different.The implant costs of endovascular aneurysm repair are substantial. When evaluating total health care system expenditures, there is large individual variability in costs, and there is no significant difference at 2 years among systems or when an individual system is compared with open repair.