VESS31. Index and Follow-Up Costs of Endovascular Abdominal Aortic Aneurysm Repair from the Endurant Stent Graft System Post Approval Study

Early trials for endovascular aortic repair (EVAR) report greater overall health benefit, but also higher costs compared with open repair. However, few have examined the subsequent cost of follow-up evaluations and secondary reinterventions. Therefore, we present the early and late costs of EVAR from the Endurant Stent Graft System Post Approval Study (ENGAGE PAS). From August 2011 to June 2012, 178 patients were enrolled in the ENGAGE PAS de novo cohort and treated with the Endurant stent graft system (Medtronic, Dublin, Ireland), of whom 171 (96%) consented for inclusion in the economic analysis and 177 participated in the quality of life assessment over a 5-year follow-up period. Cost data for the index and follow-up hospitalizations were tabulated directly from hospital bills and categorized by Uniform Billing codes. Surgeon costs were calculated by Current Procedural Terminology codes for each intervention. Current Procedural Terminology codes were also used to impute imaging and clinic follow-up costs based on yearly average Medicare payment rates. Additionally, we compared aneurysm-related versus nonaneurysm-related secondary hospitalization costs and report EQ-5D quality of life dimensions. The mean total hospital cost per person for the index EVAR was $45,304, with a range from $10,146 to $712,394 (median, $32,166; interquartile range [IQR], $25,932-$44,784). The largest contributor to the overall cost was the EVAR device itself, which accounted for 44% of the total cost at a mean of $20,000 per person. One hundred patients had 233 additional postindex admission inpatient encounters, most frequently occurring between follow-up years 1 and 2 (Fig). Only 29 (12%) were aneurysm related, with a median cost of $13,370 (IQR, $4,570-24,153) compared with a nonaneurysm-related median cost of $6,609 (IQR, $1,244-$26,465). Additionally, 30 patients were admitted a total of 35 times for secondary procedures after index admission, of which 15 (43%) were aneurysm related. The median cost of hospitalization for aneurysm-related secondary intervention was $23,322 (IQR, $15,954-$68,530), compared with median nonaneurysm-related secondary intervention cost of $19,007 (IQR, $8708-$33,301). Outpatient follow-up imaging costs averaged $475 per person per year ($422 for computed tomography scans, $53 for KUB), while annual office visits averaged $107 per person per year, for a total follow-up cost of $582 per person per year. There were no significant differences in the five EQ-5D quality of life dimensions or the health score at each follow-up compared with baseline. Costs associated with index EVAR are driven primarily by the device cost. Secondary readmissions are largely nonaneurysm related; however, cost of aneurysm-related hospitalizations is higher than for nonaneurysm admissions. These data will serve as a baseline for comparison with open repair and other devices.