A platform for research: civil engineering, architecture and urbanism
A platform for research: civil engineering, architecture and urbanism
Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms:Results of a randomized trial
Background: Two randomized trials have shown similar mid-term outcomes for survival and quality of life after endovascular and conventional open repair of abdominal aortic aneurysms (AAA). With reduced hospital and intensive care stay, endovascular repair has been hypothesized to be more efficient than open repair. The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial was undertaken to assess the balance of costs and effects of endovascular vs open aneurysm repair. Methods: We conducted a multicenter, randomized trial comparing endovascular repair with open repair in 351 patients with an AAA and studied costs, cost-effectiveness, and clinical outcome 1 year after surgery. In addition to clinical outcome, costs and quality of life were recorded up to 1 year in 170 patients in the endovascular repair group and in 170 in the open repair group. Incremental cost-effectiveness ratios were estimated for cost per life-year, event-free life-year, and quality adjusted life-year (QALY) gained. Uncertainty regarding these outcomes was assessed using bootstrapping. Results: Patients in the endovascular repair group experienced 0.72 QALY vs 0.73 in the open repair group (absolute difference, 0.01; 95% confidence interval [CI], -0.038 to 0.058). Endovascular repair was associated with additional is an element of 4293 direct costs (is an element of 18,179 vs is an element of 13.886; 95% CI, is an element of 2,770 to is an element of 5,830). Most of the bootstrap estimates indicated that endovascular repair resulted in slightly longer overall and event-free survival associated with respective incremental cost-effectiveness ratios of 76,100 and 171,500 per year gained. Open repair appeared the dominant strategy in costs per QALY. Conclusion: Presently, routine use of endovascular repair in patients also eligible for open repair does not result in a QALY gain at 1 year postoperatively, provides only a marginal overall survival benefit, and is associated with a substantial, if not prohibitive, increase in costs.
Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms:Results of a randomized trial
Background: Two randomized trials have shown similar mid-term outcomes for survival and quality of life after endovascular and conventional open repair of abdominal aortic aneurysms (AAA). With reduced hospital and intensive care stay, endovascular repair has been hypothesized to be more efficient than open repair. The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial was undertaken to assess the balance of costs and effects of endovascular vs open aneurysm repair. Methods: We conducted a multicenter, randomized trial comparing endovascular repair with open repair in 351 patients with an AAA and studied costs, cost-effectiveness, and clinical outcome 1 year after surgery. In addition to clinical outcome, costs and quality of life were recorded up to 1 year in 170 patients in the endovascular repair group and in 170 in the open repair group. Incremental cost-effectiveness ratios were estimated for cost per life-year, event-free life-year, and quality adjusted life-year (QALY) gained. Uncertainty regarding these outcomes was assessed using bootstrapping. Results: Patients in the endovascular repair group experienced 0.72 QALY vs 0.73 in the open repair group (absolute difference, 0.01; 95% confidence interval [CI], -0.038 to 0.058). Endovascular repair was associated with additional is an element of 4293 direct costs (is an element of 18,179 vs is an element of 13.886; 95% CI, is an element of 2,770 to is an element of 5,830). Most of the bootstrap estimates indicated that endovascular repair resulted in slightly longer overall and event-free survival associated with respective incremental cost-effectiveness ratios of 76,100 and 171,500 per year gained. Open repair appeared the dominant strategy in costs per QALY. Conclusion: Presently, routine use of endovascular repair in patients also eligible for open repair does not result in a QALY gain at 1 year postoperatively, provides only a marginal overall survival benefit, and is associated with a substantial, if not prohibitive, increase in costs.
Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms:Results of a randomized trial
Prinssen, Monique (author) / Buskens, Erik (author) / de Jong, Sjors E. (author) / Buth, Jacob (author) / Mackaay, Albert J. (author) / Sambeek, Marc R. (author) / Blankensteijn, Jan D. (author)
2007-11-01
Prinssen , M , Buskens , E , de Jong , S E , Buth , J , Mackaay , A J , Sambeek , M R , Blankensteijn , J D & null, null 2007 , ' Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms : Results of a randomized trial ' , Journal of Vascular Surgery , vol. 46 , no. 5 , pp. 883-890 . https://doi.org/10.1016/j.jvs.2007.07.033 ; ISSN:0741-5214
Article (Journal)
Electronic Resource
English
OPEN SURGICAL REPAIR , MULTICENTER , QUALITY-OF-LIFE , STATES , AAA REPAIR , STANDARDS , OUTCOMES , DESIGN , HEALTH
DDC:
690
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