Cost-effectiveness analysis of repairs of complex abdominal aortic aneurysms: a systematic review

Modou Diop (diop@go.ugr.es) and David M. Epstein (davidepstein@ugr.es)
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Modou Diop: University of Granada, Spain. Department of Applied Economics
David M. Epstein: University of Granada, Spain. Department of Applied Economics

No 01/22, FEG Working Paper Series from Faculty of Economics and Business (University of Granada)

Abstract: Background: Complex abdominal aortic aneurysms, cAAA, include juxta-renal, JRAAA, and thoraco-abdominal, TAAA. Interventions to repair these conditions are associated with high costs and possible clinical complications such as spinal cord injury (SCI) or paraplegia. Objectives: The aim was to estimate the costs and health resources used, along with measures of effectiveness and complications associated with these interventions. Methods: A systematic search was conducted for economic evaluations or cost-effectiveness studies in the bases of Medline, Embase, Scopus and the Centre for Reviews and Dissemination. Currencies were converted into euros at 2018 purchasing power parities. Results: This study has reviewed the literature on the cost-effectiveness of surgical treatments for cAAA. The 4 included studies were heterogenous in populations, treatments and how costs were reported. The 30-day cost of JRAAA or infradiaphragmatic TAAA with endovascular intervention, EI, is in the range 27,000€ to 38,000€. More challenging supradiaphragmatic TAAA endovascular procedures cost more, about 55,000€, and the most complex EI for Crawford Type II and III TAAA cost about 125,000$ (89125€) over 1 year. Open surgical intervention, SI, may cost less than EI in JRAAA or infradiaphragmatic TAAA but there does not appear to be a difference in more complex conditions. Discussion: SCI is rare but may occur in up to 20% of complex TAAA. The average cost was estimated as $463,116 (330,000€) for the first year and $61,550 (44,000€) thereafter. However, the US health and social care system may not represent the situation in Europe. Further cost effectiveness studies are needed in cAAA and TAAA. They should ensure that the population, interventions and outcomes are accurately defined, outcomes are reported according to recognised guidelines, include complications and SCI as relevant, and are conducted over a sufficient time horizon to capture the long term sequella.

Keywords: : complex aneurysms; TAAA complex; open repair; endovascular repair; cost effectiveness or economic evaluation; socioeconomic impact (search for similar items in EconPapers)
Pages: 9 pages
Date: 2022-02-24
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