0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Long-term Cost-effectiveness in the Veterans Affairs Open vs Endovascular Repair Study of Aortic Abdominal Aneurysm A Randomized Clinical Trial ONLINE FIRST

Frank A. Lederle, MD1; Kevin T. Stroupe, PhD2; Tassos C. Kyriakides, PhD3; Ling Ge, MS2; Julie A. Freischlag, MD4 ; for the Open vs Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group
[+] Author Affiliations
1Department of Medicine, Veterans Affairs (VA) Medical Center, Minneapolis, Minnesota
2Center of Innovation for Complex Chronic Healthcare, VA Medical Center, Hines, Illinois
3VA Cooperative Studies Program Coordinating Center, VA Medical Center, West Haven, Connecticut
4School of Medicine, University of California, Davis, Sacramento
JAMA Surg. Published online September 14, 2016. doi:10.1001/jamasurg.2016.2783
Text Size: A A A
Published online

Importance  Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure.

Objective  To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair.

Design, Setting, and Participants  This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat.

Main Outcomes and Measures  Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY).

Results  A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89 in the endovascular group and 4.84 in the open repair group (P = .68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P = .82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, −$10 788; 95% CI, −$29 796 to $5825; P = .25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, −$393; 95% CI, −$12 071 to $7928; P = .94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs.

Conclusions and Relevance  In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

Trial Registration  clinicaltrials.gov Identifier: NCT00094575

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.
CONSORT Diagram

Randomization and treatment of study patients. Adapted from Lederle et al.5 AAA indicates abdominal aortic aneurysm.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Cost-effectiveness Planes

Bootstrap replications show the differences in costs, life-years, and quality-adjusted life-years (QALYs) on the cost-effectiveness plane between patients randomized to endovascular or open repair of abdominal aortic aneurysm (AAA). Differences are calculated as the endovascular repair group finding minus the open repair group finding. The large dot indicates the point estimate from the study. Solid diagonal line indicates willingness to pay $50 000 per life-year or QALY; dashed diagonal line, willingness to pay $100 000 per life-year or QALY.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,228 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Abdominal Aortic Aneurysm

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Abdominal Aortic Aneurysm

brightcove.createExperiences();