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Health Policy and Practice |
1 From the Departments of Radiology (J.L.B., J.S.L., P.M.M., M.T.B., E.F.H., J.A.K., G.S.G.) and Vascular Surgery (D.C.B.), Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Suite 2H, Boston, MA 02114; Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (G.S.G.); and Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands (J.L.B.). Received September 5, 2000; revision requested October 17; final revision received January 30, 2001; accepted February 15. Address correspondence to J.L.B. (e-mail: johanna@the-data-group.org).
PURPOSE: To determine and compare the average in-hospital costs of elective open surgical and endovascular repairs of infrarenal abdominal aortic aneurysms.
MATERIALS AND METHODS: Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal aortic aneurysms between 1997 and 1999 were retrieved. The mean total hospital cost (including stent-graft costs and excluding attending physician fees) and mean postoperative length of stay were calculated for each treatment group. Costs were expressed in 1999 U.S. dollars.
RESULTS: Endovascular repair yielded a shorter postoperative length of stay than did open surgery (mean stay, 3.4 vs 8.0 days; P < .001) and a lower proportion of patients who were admitted to the intensive care unit for 1 full day or longer (2.8% vs 36.3%; P < .001). The mean total hospital cost was significantly higher for endovascular repair than for open surgery ($20,716 vs $18,484; P < .001).
CONCLUSION: Hospital costs were higher for endovascular repair than for open surgical repair. However, endovascular repair was associated with a decreased length of stay and fewer intensive care unit admissions. The increased mean hospital cost for endovascular repair was smaller than one would expect, considering the higher costs of endovascular grafts, as compared with those for surgical grafts (approximately $6,400 according to literature data).
Index terms: Aneurysm, aortic, 981.73 • Aorta, grafts and prostheses, 981.1286 • Aorta, interventional procedures, 981.1286 • Cost-effectiveness • Economics, medical
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