This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Long‐term cost‐effectiveness analysis of endovascular versus open repair for abdominal aortic aneurysm based on four randomized clinical trials. BJS 2014; 101: 623-631.

Published: 24th March 2014

Authors: D. Epstein, M. J. Sculpher, J. T. Powell, S. G. Thompson, L. C. Brown, R. M. Greenhalgh et al.

Background

A number of published economic evaluations of elective endovascular aneurysm repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA) have come to differing conclusions about whether EVAR is cost‐effective. This paper reviews the current evidence base and presents up‐to‐date cost‐effectiveness analyses in the light of results of four randomized clinical trials: EVAR‐1, DREAM, OVER and ACE.

Method

Markov models were used to estimate lifetime costs from a UK perspective and quality‐adjusted life‐years (QALYs) based on the results of each of the four trials. The outcomes included in the model were: procedure costs, surveillance costs, reintervention costs, health‐related quality of life, aneurysm‐related mortality and other‐cause mortality. Alternative scenarios about complications, reinterventions and deaths beyond the trial were explored.

Results

Models based on the results of the EVAR‐1, DREAM or ACE trials did not find EVAR to be cost‐effective at thresholds used in the UK (up to £30 000 per QALY). EVAR seemed cost‐effective according to models based on the OVER trial. These results seemed robust to alternative model scenarios about events beyond the trial intervals.

Conclusion

These analyses did not find that EVAR is cost‐effective compared with open repair in the long term in trials conducted in European centres. EVAR did appear to be cost‐effective based on the OVER trial, conducted in the USA. Caution must be exercised when transferring the results of economic evaluations from one country to another.

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