Abstract
Background: It has become increasingly important to evaluate the cost effectiveness of alternative interventions. The aim of this study was to assess the clinical results and costs of endovascular repair (EVAR) and open surgical repair (OSR) of thoracic aortic aneurysms. Methods: The case-control study included 14 patients treated by EVAR and 9 patients who underwent OSR. Early and midterm outcomes as well as costs were examined. A decision tree model was also developed to evaluate the costs of EVAR and OSR of the descending thoracic aortic aneurysms under the Japanese Diagnosis Procedure Combination based payment system. Clinical outcome data derived from current Japanese reports were used for this model analysis. Results: In the case-control study, no midterm difference was observed between EVAR and OSR regarding hospital mortality or aneurysm-related mortality. The hospital cost of EVAR was significantly less than that of OSR (¥2,620,000 ± 169,000 versus ¥6,942,000 ± 861,000, p < 0.01). In the model analysis, the total cost estimate of EVAR was consistently less than that of OSR over a range of sensitivity analyses. In addition, EVAR appeared no worse than OSR in view of the clinical outcome based on Japanese reports. Conclusion: These results suggest that EVAR is a cost-effective alternative compared with OSR for the treatment of thoracic aortic aneurysm.
