Skip to main content

Advertisement

SpringerLink
Log in

Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

We conducted this study to compare the cost of open surgical repair (OR) with that of endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA).

Methods

Between January 2007 and November 2008, 70 patients underwent open repair and 57 patients underwent EVAR. We evaluated the total cost, including that of the Diagnosis Procedure Combination (DPC), that of the surgical procedure, that of materials such as grafts and guide wires, and that of the anesthesia.

Results

The mean costs for OR versus EVAR were as follows: DPC, ¥632370 versus ¥490050, respectively, which was significant; anesthesia, ¥123540 versus ¥86220, respectively (P < 0.05); and materials, ¥257770 versus ¥2113280, respectively (P < 0.05). Thus, the mean total cost was ¥1825830 versus ¥3159270 for open repair and EVAR, respectively (P < 0.05).

Conclusions

New technologies should not only be clinically effective, but also cost effective. EVAR is less invasive clinically, but the cost of endovascular prostheses and other materials remains high.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–9.

    Article  PubMed  CAS  Google Scholar 

  2. Moore WS, Rutherford RB, for the EVT Investigators. Transfemoral endovascular repair of abdominal aortic aneurysm: results of the North American EVT phase 1 trial. J Vasc Surg. 1996;23:543–53.

    Article  PubMed  CAS  Google Scholar 

  3. Moore WS, Brewster DC, Bernhard VM, for the EVT/Guidant Investigators. Aorto-uni-iliac endograft for complex aorto-iliac aneurysms compared with tube/bifurcation endografts: results of the EVT/Guidant trials. J Vasc Surg. 2001;33(suppl):S11–20.

    Article  PubMed  CAS  Google Scholar 

  4. Makaroun MS, Chaikof E, Naslund P, Matsumura JS, for the EVT investigators. Efficacy of a bifurcated endograft versus open repair of abdominal aortic aneurysms: a reappraisal. J Vasc Surg. 2002;35:203–10.

    Article  PubMed  Google Scholar 

  5. Moore W, Matsumura JS, Makaroun MS, EVT/Guidant Investigators. Five-year interim comparison of the Guidant bifurcated endograft with open repair of abdominal aortic aneurysm. J Vasc Surg. 2003;38:46–55.

    Article  PubMed  Google Scholar 

  6. Zarins CK, White RA, Shwarten DE, Kinney E, Diethrich EB, Hodgson KJ, et al. AneuRx stent graft system versus open surgical repair of abdominal aortic aneurysms: multicenter prospective clinical trial. J Vasc Surg. 1999;29:292–308.

    Article  PubMed  CAS  Google Scholar 

  7. Matsumura JS, Brewster DC, Makaroun MS, Naftel DC. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg. 2003;37:262–71.

    Article  PubMed  Google Scholar 

  8. Greenberg R. Zenith Investigators. The Zenith AAA endovascular graft for abdominal aortic aneurysms: clinical update. Semin Vasc Surg. 2003;16:151–7.

    Article  PubMed  Google Scholar 

  9. Hori D, Yuri K, Nemoto K, Yamaguchi K, Adachi H. Successful treatment of an abdominal aortic aneurysm by endovascular graft through a previously placed prosthetic graft: report of a case. Surg Today. 2010;40:1169–72.

    Article  PubMed  Google Scholar 

  10. Hoshina K, Kato M, Mikuriya A, Ohkubo N. Successful endovascular repair in two cases of graft limb occlusion after endovascular aneurysm repair for abdominal aortic aneurysms. Surg Today. 2010;40:487–90.

    Article  PubMed  Google Scholar 

  11. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with AAA (EVAR trial 1), 30-day operative mortality results: randomized controlled trial. Lancet. 2004;364:843–8.

    Article  PubMed  CAS  Google Scholar 

  12. Prinssen M, Buskens E, Blankensteijn JD. The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. Background, design and methods. J Cardiovasc Surg. 2002;43:379–84.

    CAS  Google Scholar 

  13. Holzenbein J, Kretscmer G, Glanzl R, Schon A, Thurnher S, Winkelbauer F, et al. Endovascular AAA treatment: expensive prestige or economic alternative? Eur J Vasc Endovasc Surg. 1997;14:265–72.

    Article  PubMed  CAS  Google Scholar 

  14. Ceelen W, Sonneville T, Randon C, De Roose J, Vermassen F. Cost-benefit analysis of endovascular versus open abdominal aortic aneurysm treatment. Acta Chir Belg. 1999;99:64–7.

    PubMed  CAS  Google Scholar 

  15. Quinones-Baldrich WJ, Garner C, Caswell D, Ahn SS, Gelabert HA, Machleder HI, et al. Endovascular, transperitoneal, and retroperitoneal abdominal aortic aneurysm repair: results and costs. J Vasc Surg. 1999;30:59–67.

    Article  PubMed  CAS  Google Scholar 

  16. Seiwert AJ, Wolfe J, Whalen RC, Pigott JP, Kritpracha B, Beebe HG. Cost comparison of aortic aneurysm endograft exclusion versus open surgical repair. Am J Surg. 1999;178:117–20.

    Article  PubMed  CAS  Google Scholar 

  17. Angle N, Dorafshar AH, Moore WS, Quinones-Baldrich WJ, Gelabert HA, Ahn SS, et al. Open versus endovascular repair of abdominal aortic aneurysms: what does each really cost? Ann Vasc Surg. 2004;18:612–8.

    Article  PubMed  Google Scholar 

  18. Forbes TL, DeRose G, Kribs S, Harris KA. A cost-effectiveness analysis of standard versus endovascular abdominal aortic aneurysm repair. Can J Surg. 2002;45:420–4.

    PubMed  Google Scholar 

  19. Birch SE, Stary DR, Scott AR. Cost of endovascular versus open surgical repair of abdominal aortic aneurysms. Aust NZ J Surg. 2000;70:660–6.

    Article  CAS  Google Scholar 

  20. Dryjski M, O’Brien-Irr MS, Hassett J. Hospital costs for endovascular and open repair of abdominal aortic aneurysm. J Am Coll Surg. 2003;197:64–70.

    Article  PubMed  Google Scholar 

  21. Sternbergh WC III, Money SR. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study. J Vasc Surg. 2000;31:237–44.

    Article  PubMed  Google Scholar 

  22. Rosenberg BL, Comstock MC, Butz DA, Taheri PA, Williams DM, Upchurch GR Jr. Endovascular abdominal aortic aneurysm repair is more profitable than open repair based on contribution margin per day. Surgery. 2005;137:285–92.

    Article  PubMed  Google Scholar 

  23. Theofanis F, Georgia T, Theophanis K, Athina K, Evangelos K, Teodosios P, et al. Cost and effectiveness comparison of endovascular aneurysm repair versus open surgical repair of abdominal aortic aneurysm: a single-center experience. J Vasc Nurs. 2008;26:15–21.

    Article  Google Scholar 

  24. Hayter CL, Bradshaw SR, Allen RJ, Guduguntla M, Hardman DT. Follow-up costs increase the cost disparity between endovascular and open abdominal aortic aneurysm repair. J Vasc Surg. 2005;42:912–8.

    Article  PubMed  Google Scholar 

  25. Bosch JL, Kaufman JA, Beinfeld MT, Adriaensen ME, Brewster DC, Gazelle GS. Abdominal aortic aneurysms; cost effectiveness of elective endovascular and open surgical repair. Radiology. 2002;225:337–44.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Hirofumi Morimae and co-authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan

    Hirofumi Morimae, Takashi Maekawa, Hiroaki Tamai, Noriko Takahashi, Tsutomu Ihara, Akihiko Hori, Hiroshi Narita, Hiroshi Banno, Masayoshi Kobayashi, Kiyohito Yamamoto & Kimihiro Komori

Authors
  1. Hirofumi Morimae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Maekawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroaki Tamai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noriko Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsutomu Ihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akihiko Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroshi Narita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroshi Banno
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masayoshi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kiyohito Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kimihiro Komori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirofumi Morimae.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morimae, H., Maekawa, T., Tamai, H. et al. Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan. Surg Today 42, 121–126 (2012). https://doi.org/10.1007/s00595-011-0041-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-011-0041-4

Keywords

Search

Navigation