Quality-adjusted life year comparison at medium term follow-up of endovascular versus open surgical repair for abdominal aortic aneurysm in young patients

• Published in: PloS one Vol. 16; no. 12; p. e0260690
• Main Authors: Byun, Eunae, Kwon, Tae-Won, Kim, Hyangkyoung, Cho, Yong Pil, Han, Youngjin, Ko, Gi Young, Jeong, Min-Jae
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.12.2021; Public Library of Science (PLoS)
• Subjects: Abdominal aneurysm; Aged; Aorta; Aortic Aneurysm, Abdominal - pathology; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Aortic dissection; Biology and Life Sciences; Cardiovascular system; Care and treatment; Cost analysis; Cost effectiveness; Cost-Benefit Analysis; Costs; Decision making; Economic aspects; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - economics; Endovascular Procedures - adverse effects; Endovascular Procedures - economics; Evaluation; Female; Follow-Up Studies; General anesthesia; Health aspects; Heart attacks; Hospitals; Humans; Local anesthesia; Male; Medical care, Cost of; Medical schools; Medicine; Medicine and Health Sciences; Middle Aged; Morphology; Patients; Postoperative Complications; Proportional Hazards Models; Quality of life; Quality-Adjusted Life Years; Research and Analysis Methods; Retrospective Studies; Risk Factors; Social Sciences; Surgeons; Treatment Outcome; Vascular surgery; South Korea; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0260690

This study aimed to compare the quality of life and cost effectiveness between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in young patients with abdominal aortic aneurysm (AAA). This was a single-center, observational, and retrospective study. A retrospective analysis was conducted of patients with AAA, who were <70 years old and underwent EVAR or OSR between January 2012 and October 2016. Only patients with aortic morphology that was suitable for EVAR were enrolled. Data on the complication rates, medical expenses, and expected quality-adjusted life years (QALYs) were collected, and the cost per QALY at three years was compared. Among 90 patients with aortic morphology who were eligible for EVAR, 37 and 53 patients underwent EVAR and OSR, respectively. No significant differences were observed in perioperative cardiovascular events and death between the two groups. However, during the follow-up period, patients undergoing OSR showed a significantly lower complication rate (hazard ratio [HR] = 0.11; P = .021). From the three-year cost-effectiveness analysis, the total sum of costs was significantly lower in the OSR group (P < .001) than that in the EVAR group, and the number of QALYs was superior in the OSR group (P = .013). The cost per QALY at three years was significantly lower in the OSR group than that in the EVAR group (mean: $4038 vs. $10 137; respectively; P < .001). OSR had lower complication rates and better cost-effectiveness than EVAR Among young patients with feasible aortic anatomy.