Long-term postplacement cost after endovascular aneurysm repair

Area of Science:

• Vascular Surgery
• Health Economics
• Medical Device Technology

Background:

• Initial hospital costs for endovascular aneurysm repair (EVAR) are established around $20,000.
• Long-term surveillance and secondary procedure costs following EVAR remain poorly quantified.

Purpose of the Study:

• To characterize the long-term postplacement costs associated with endovascular aneurysm repair (EVAR).
• To identify patient subgroups incurring disproportionately higher costs after EVAR.

Main Methods:

• Analysis of 259 patients undergoing EVAR for infrarenal aneurysms between 1998 and 2006.
• Calculation of follow-up costs using a relative value unit-based hospital accounting system.
• Inclusion of institutional overhead and professional service costs; exclusion of early learning curve cases.

Main Results:

• The cumulative 5-year postplacement cost per patient was $11,351.
• Patients requiring secondary procedures incurred 8.6-fold higher 5-year costs ($31,696 vs. $3668).
• Patients with endoleaks had 4.7-fold higher 5-year costs ($26,739 vs. $5706), with secondary procedures and radiologic studies as major cost drivers.

Conclusions:

• Postplacement costs increase the global cost of EVAR by 44% over 5 years.
• Endoleaks and secondary procedures significantly drive up post-EVAR costs.
• Future cost-reduction strategies should focus on minimizing endoleaks and the need for reintervention.