Ten years ago, endovascular aortic repair (EVAR) was FDA-approved to treat abdominal and thoracic aortic aneurysms. Now, a one-year trial study published in the October issue of the Journal of Vascular Surgery, published by the Society for Vascular Surgery, reports EVAR, a minimally-invasive technique, results in better surgical outcomes than open surgical repair (OSR) while maintaining similar costs.
According to the American Heart Association, an aortic aneurysm is a bulge in a blood vessel that are dangerous due to the risk of bursting, spilling blood outside of the aorta and leaving a person at risk for hemorrahaging within the abdominal cavity. Thee aneurysms usually occur in the abdomen below the kidneys (known as abdominal aneurysm), but may occur in the chest cavity (thoracic aneurysm).
When found, aneurysms are treated surgically with a patch or artificial piece of blood vessel is sewn in to reinforce the aorta.
The study collected data from 342 patients with an abdominal aortic aneurysm (AAA) of more than 5.5 centimeters, calling for elective AAA repair at London Health Sciences Center (LHSC), London, Ontario, Canada, where EVAR has been practices since 1997. Of the patients in the study, 192 were at high-risk of postoperative complications—140 received EVAR and 52 received OSR.
The one-year, non-randomized prospective study looked at demographic, medical, health care resource utilization, cost and quality of life to determine costs and effects associated with each of these procedures.
Sensitivity analyses extrapolated one-year mortality results within a five-year duration under various assumptions regarding convergence of mortality rates and re-intervention rates for the EVAR patients only. According to Dr. Guy De Rose, MD, medical director of surgical care at LHSC and an associate professor of surgery from the division of vascular surgery at the University of Western Ontario in London, Ontario, Canada, OSR patients were found to be more frequently at high-risk of surgical complications than EVAR patients, despite similar baseline characteristics.
“The 30-day mortality rates were 0.7 percent for EVAR and 9.6 percent for OSR and significantly fewer EVAR patients had postoperative complications such as pulmonary edema, pneumonia or sepsis,” says Dr. De Rose. “In addition, the EVAR patients spent less day in the hospital and were less likely to be admitted to the ICU.”
Additionally, despite the cost of the endograft, which is approximately $10,000, the total average initial costs of hospitalization for high-risk EVAR and OSR patients were close, at $28,139 and $31,181 respectively. Total medical and indirect costs after one-year where also similar, at $34,146 vs. $34,170 respectively. Most importantly, the one-year, all-cause mortality was statistically lower in EVAR patients at 7.1 percent, versus 17.3 percent. Finally, Dr. De Rose reports the quality of life was similar among both sets of patients.
These findings concluded that in a five-year duration, EVAR may be more cost-effective compared to OSR in high-risk patients in the long-term.
“Our study found that EVAR was a cost-effective strategy compared to OSR in high risk patients and had lower postoperative complications and lower mortality rates,” says Dr. De Rose. “We are continuing to gather notes on these patients and the longer-term results will supply more info regarding the cost-effectiveness of EVAR compared to OSR in high risk patients.”
In the end, the study reveals EVAR may be a minimally-invasive, safe, cost-effective solution to AAA, and one that despite its 10-year longevity, has yet to become a standard of surgical care.
American Heart Association
The LHSC collaborated with the Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph’s Healthcare Hamilton/McMaster University in Hamilton, Ontario, Canada on the current study. The study was conducted at the demand of the Ontario Ministry of Health and Long-Term Care to supply evidence to the Ontario Health Technology Advisory Committee to support policy recommendations regarding the use of EVAR in Ontario.