Value-Based Medicine in the Management of Abdominal Aortic Aneurysms

The implementation of value-based medicine reflects a transformation from volume incentivized care to a quality-of-care directed reimbursement model. Value-based medicine aims to concurrently improve health care quality and control growing health care expenditures by aligning evidence-based and patient-centered interventions with sustainable resource use. We apply a value-based medicine framework to abdominal aortic aneurysm care delivery, highlighting opportunities to improve patient outcomes, optimize resource allocation, and reduce health care expenditures across the continuum of disease management. A comprehensive literature review was conducted, evaluating recent clinical guidelines, economic analyses, and real-world practice data on abdominal aortic aneurysm management, including screening, surveillance, timing of intervention, modality selection (endovascular aneurysm repair versus open surgical repair), and follow-up strategies. Contemporary real-world published practice patterns reveal wide variation in screening uptake, surveillance intensity, repair criteria thresholds, procedure and device selection, and post-endovascular aneurysm repair imaging, producing inconsistent outcomes and inefficient spending. Endovascular aneurysm repair predominates in elective abdominal aortic aneurysm repair because of lower perioperative morbidity and shorter length of stay; however, downstream costs from surveillance, endoleak management, and reinterventions may erode its initial economic advantage over open surgical repair. Key value drivers include risk-aligned screening, standardized surveillance anchored to anatomy and device risk, judicious use of advanced imaging, optimized perioperative pathways, and careful device selection. Savings opportunities include predictive analytics to individualize surveillance, deescalation of routine computed tomography after documented sac shrinkage, smoking cessation, medical optimization, and structured shared decision-making aligned with life expectancy and patient preferences. Integrating value-based medicine principles into abdominal aortic aneurysm care through regional centers of excellence, bundled reimbursement models, transparent cost structures, and surveillance strategies may offer a pragmatic roadmap to achieve safer, economically sustainable, and patient-centered management, ultimately advancing both clinical outcomes and cost efficiency.