Cost-effectiveness at two years in the VA open versus endovascular repair trial

Background: Long-term clinical outcomes have been similar for endovascular and open repair of abdominal aortic aneurysm (AAA), increasing the importance of comparing cost-effectiveness. Methods: We compared data to two years from a multicenter randomized trial of 881 patients. Quality-adjusted life years (QALYs) were calculated from EQ-5D questionnaires. Healthcare utilization data were obtained from patients and from national VA and Medicare sources. VA costs were obtained using methods previously developed by the VA Health Economics Resource Center. Costs for non-VA care were determined from Medicare or billing data. Results: Mean life-years were 1.78 in the endovascular and 1.74 in the open repair group (P = 0.29), and mean QALYs were 1.462 in the endovascular and 1.461 in the open group (P = 0.78). Although graft costs were higher in the endovascular group ($14,052 vs. $1363; P < 0.001), length of stay was shorter (5.0 vs. 10.5 days; P < 0.001), resulting in lower cost of AAA repair hospitalization in the endovascular group ($37,068 vs. $42,970; P = 0.04). Costs remained lower after 2 years in the endovascular group but the difference was no longer significant (-$5019; 95% CI: -$16,720 to $4928; P = 0.35). The probability that endovascular repair was both more effective and less costly was 70.9% for life-years and 51.4% for QALYs. Interpretation: Endovascular repair is a cost-effective alternative to open repair in the US VA healthcare system for at least the first two years.