Cost-effectiveness analysis of surgical repair versus observation of complex abdominal aortic aneurysms in elderly patients

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2026-03-01 Epub Date: 2025-10-09 DOI:10.1016/j.jvs.2025.09.051

Hataka R. Minami MD, MS, Erin K. Greenleaf MD, MS, Besma J. Nejim MD, MPH, Sai Prasada Rao Manikonda BS, Neal R. Barshes MD, MPH

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引用次数: 0

Abstract

Objective

The operative risks and financial costs associated with fenestrated endovascular aneurysm repair (FEVAR) and open surgical repair (OSR) of complex abdominal aortic aneurysms may not be justified in elderly patients because of limited expected survival. We performed a cost-effectiveness analysis to determine whether FEVAR or OSR was preferable to observation in elderly patients with complex abdominal aortic aneurysms.

Methods

We constructed a probabilistic Markov model comparing lifetime costs and survival (in quality-adjusted life years or QALYs) among patients undergoing FEVAR vs OSR vs observation. Cohorts undergoing aneurysm repair were exposed to risk of complications, reintervention, or death, whereas those undergoing observation were exposed to risk of rupture. Baseline mortality was modeled from a national life table. Outcomes were costs in U.S. dollars, QALYs, and incremental cost-effectiveness ratios. Sensitivity analyses were performed for various combinations of age at the time of repair (range: 50-90 years), sex, and aneurysm size (range: 5.5-8.5 cm/5.0-8.5 cm in men/women, respectively).

Results

FEVAR tended to have better survival than OSR for 70-year-old men with 5.5-cm aneurysms (6.5 vs 5.7 QALYs, respectively) and 70-year-old women with 5.0-cm aneurysms (8.0 vs 7.2 QALYs, respectively). However, FEVAR and OSR led to comparable costs in these cohorts. As such, FEVAR was preferred over OSR in these cohorts. Incremental cost-effectiveness ratios of FEVAR vs observation were $27,621 and $21,653 per QALY gained in men and women, respectively. Both FEVAR and OSR were cost-effective compared with observation for most scenarios, except for age >80 to 85 years with smaller aneurysms (≤7.0 cm in men and ≤6.0 cm in women).

Conclusions

FEVAR and OSR are cost-effective compared with observation for most patients, even among elderly.

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老年复杂腹主动脉瘤手术修复与观察的成本-效果分析。

目的：复杂腹主动脉瘤（AAAs）的开窗血管内动脉瘤修复（FEVAR）和开放式手术修复（OSR）的手术风险和经济成本可能不合理，因为老年患者的预期生存期有限。我们进行了成本-效果分析，以确定FEVAR或OSR是否优于观察老年复杂AAAs患者。方法：我们构建了一个概率马尔可夫模型，比较FEVAR、OSR和观察患者的终生成本和生存率（质量调整生命年，或QALYs）。接受动脉瘤修复的患者面临并发症、再干预或死亡的风险，而接受观察的患者面临动脉瘤破裂的风险。基线死亡率是根据国家生命表建模的。结果是以美元计算的成本、质量年和增量成本-效果比。对修复时的年龄（50 - 90岁）、性别和动脉瘤大小（男性/女性分别为5.5 - 8.5 cm / 5.0 - 8.5 cm）的各种组合进行敏感性分析。结果：70岁男性5.5 cm动脉瘤（分别为6.5 vs 5.7 QALYs）和70岁女性5.0 cm动脉瘤（分别为8.0 vs 7.2 QALYs）的FEVAR生存率优于OSR。然而，在这些队列中，FEVAR和OSR导致的费用相当。因此，在这些队列中，FEVAR优于OSR。在男性和女性中，FEVAR与观察的增量成本-效果比分别为每QALY增加27,621美元和21,653美元。与观察结果相比，FEVAR和OSR在大多数情况下都具有成本效益，除了年龄在80 - 85岁之间的较小动脉瘤（男性< 7.0 cm，女性< 6.0 cm）。结论：与大多数患者相比，FEVAR和OSR具有成本效益，即使在老年人中也是如此。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.