Open Versus Endovascular Repair With Covered Stents for Complex Aortoiliac Occlusive Disease: Cost Analysis Results
Elda Chiara Colacchio1, Francesco Squizzato1, Deris Gianni Boemo2
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
Insights
For complex aortoiliac occlusive disease (AIOD), open surgical repair and endovascular techniques show similar in-hospital costs and medium-term outcomes. Neither revascularization method significantly impacted total hospitalization costs or long-term survival.
Area of Science:
- Vascular Surgery
- Health Economics
- Interventional Cardiology
Background:
- Complex aortoiliac occlusive disease (AIOD) requires revascularization.
- Comparing open surgical repair versus endovascular techniques is crucial for cost-effectiveness.
- In-hospital clinical outcomes and detailed hospitalization costs are key comparison points.
Purpose of the Study:
- To evaluate the cost-effectiveness of open versus endovascular revascularization for complex AIOD.
- To compare in-hospital clinical outcomes and detailed hospitalization costs between the two techniques.
- To identify predictors of long-term mortality and primary patency.
Main Methods:
- Observational, single-center, retrospective cohort study (May 2008-February 2018).
- Included patients with Type C and D AIOD undergoing aorto-bifemoral bypass or covered kissing stenting.
- Compared costs and used logistic regression and Cox proportional hazard models for outcomes analysis.
Main Results:
- 50 patients in each group (open surgical repair vs. endovascular repair).
- Open repair group had longer hospitalization and higher complication rates (P < 0.001 and P = 0.003, respectively).
- No significant differences in total hospitalization costs, medium-term survival (P = 0.298), or primary patency (P = 0.188) were found.
Conclusions:
- Total in-hospital stay cost analysis revealed no significant differences between aorto-bifemoral bypasses and covered kissing stentings for AIOD revascularization.
- Neither revascularization strategy demonstrated a significant impact on overall medium-term survival or primary patency.
- Cost-effectiveness is comparable between open and endovascular approaches for complex AIOD.
Background:
The aim of this work is to value cost-effectiveness of complex aortoiliac occlusive disease (AIOD) revascularization, by comparing in-hospital clinical outcomes and detailed costs of hospitalization of open and endovascular techniques.
Methods:
This observational single-center retrospective cohort study included all patients who underwent AIOD revascularization from May 2008 to February 2018 and met inclusion and exclusion criteria. Patients were divided into 2 groups: open surgical repair and endovascular repair. Inclusion criteria were type C and D AIOD, and type of intervention: aorto-bifemoral bypass and covered kissing stenting. Costs were directly compared between the 2 groups, and subsequently a multivariate logistic regression model was performed to define which group most influenced major in-hospital costs. Cox proportional hazard models were used to identify predictors of long-term mortality and primary patency (PP).
Results:
The 2 groups included 50 patients each, and all patients had a bilateral iliac axis revascularization. Mean age was 67 ± 9 years and 71% of patients were males. The open surgical repair group had a significantly longer length of hospitalization (P < 0.001) and in-hospital medical complications rate (22%, P = 0.003). No differences were found in the total cumulative cost of hospitalization, including ward, intensive care unit, and operating room. In a multivariate logistic model, higher total hospitalization costs were not significantly associated with either one or the other type of treatment. We did not find any statistically significant differences in overall medium-term survival (P = 0.298) and PP (P = 0.188), which were not influenced by the type of revascularization on Cox proportional hazard models (overall survival: hazard ratio 2.09 confidence interval 95% [0.90-4.84] P = 0.082; PP: hazard ratio 1.82 confidence interval 95% [0.56-6.16] P = 0.302).
Conclusions:
Total in-hospital stay cost analysis did not reveal significant differences between aorto-bifemoral bypasses and covered kissing stentings for AIOD revascularization.
