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Abdominal Aortic Aneurysms: Cost-effectiveness of Elective Endovascular and Open Surgical Repair¹

¹ From the Departments of Radiology (J.L.B., J.A.K., M.T.B., M.E.A.P.M.A., 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.); Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands (J.L.B., M.E.A.P.M.A.); and Dotter Interventional Institute, Portland, Ore (J.A.K.). Received October 15, 2001; revision requested December 26; revision received January 29, 2002; accepted April 2. Supported in part by the U.S. Department of the Army under DAMD 17-99-2-9001. Address correspondence to J.L.B. (e-mail: johanna@the-data-group.org).

View larger version (17K): [in a new window]   Figure 1. Simplified schematic of the decision tree. = decisions, = uncertain events.

View larger version (57K): [in a new window]   Figure 2. Graph depicts the optimal treatment strategy in a two-way sensitivity analysis with a varied ratio for costs of endovascular repair versus those of open surgery and with varied rates of systemic-remote complications after endovascular repair. The arrows indicate the values of the variables used in the base-case analysis. The area with vertical lines indicates that the optimal treatment option is open surgery (ie, more clinically effective at a lower cost or the incremental CER [ICER] for endovascular repair was greater than $75,000). The white areas indicate that the optimal treatment option is endovascular repair if society is willing to pay as much as $75,000 per QALY gained (*). In area A, endovascular repair was more clinically effective and more costly than open surgery. In area B, endovascular repair was less clinically effective and less costly than open surgery. The area with horizontal lines indicates that the optimal treatment option is endovascular repair (ie, more clinically effective at a lower cost).

View larger version (62K): [in a new window]   Figure 3. Graph depicts the optimal treatment strategy in a two-way sensitivity analysis with varied annual long-term failure rates and annual rupture rates after endovascular repair. The arrows indicate the values of the variables used in the base-case analysis. The area with vertical lines indicates that the optimal treatment option is open surgery (ie, more clinically effective at a lower cost or the incremental CER [ICER] for endovascular repair was greater than $75,000). The white area indicates that the optimal treatment option is endovascular repair if society is willing to pay as much as $75,000 per QALY gained (*). The area with horizontal lines indicates that the optimal treatment option is endovascular repair (ie, more clinically effective at a lower cost).