J Korean Med Sci.  2012 Apr;27(4):416-422. 10.3346/jkms.2012.27.4.416.

Comparison of Costs of Endovascular Repair versus Open Surgical Repair for Abdominal Aortic Aneurysm in Korea

• Min SI
• Min SK
• Ahn S
• Kim SM
• Park D
• Park T
• Chung JW
• Park JH
• Ha J
• Kim SJ
• Jung IM

• KMID: 2157903
• DOI: http://doi.org/10.3346/jkms.2012.27.4.416

Abstract

This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized.

Keyword

Aortic Aneurysm, Abdominal; Endovascular Repair; Open Surgical Repair; Cost Effectiveness

MeSH Terms

Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal/economics/mortality/*surgery
Blood Vessel Prosthesis Implantation/*economics
Cost-Benefit Analysis
Endoleak
Female
Follow-Up Studies
Humans
Insurance, Health, Reimbursement
Magnetic Resonance Angiography
Male
Middle Aged
Republic of Korea
Survival Analysis
Treatment Outcome
Vascular Surgical Procedures/*economics

Figure

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  Fig. 1 Patient survival and the causes of death in both groups. OSR, open surgical repair; EVAR, endovascular repair; AMI, acute myocardial infarction; ICH, intracranial hemorrhage.

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  Fig. 2 Cost structures for OSR and EVAR. (A) Preoperative costs, (B) Postoperative costs including costs for ICU stay, and (C) cost for procedure per se. OSR, open surgical repair; EVAR, endovascular repair.

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  Fig. 3 Cost structure in OSR and EVAR group during the index admission. (A) total hospital cost, (B) patient payments and (C) NHI reimbursement. OSR, open surgical repair; EVAR, endovascular repair; NHI, National Health Insurance.

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  Fig. 4 Aneurysm-related costs for follow-up after discharge. OSR, open surgical repair; EVAR, endovascular repair.

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