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Invited Commentary
September 14, 2016

The Balance of Open vs Endovascular Aneurysm RepairCost Equipoise

Author Affiliations
  • 1Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville
JAMA Surg. Published online September 14, 2016. doi:10.1001/jamasurg.2016.2831

This issue of JAMA Surgery reports a follow-up to 9 years of the Open vs Endovascular Repair (OVER) trial population,1 including 881 patients from 42 Veterans Affairs medical centers, in which Lederle and colleagues2 analyze the management of abdominal aortic aneurysm (AAA) repair based on cost. Whether examining mean life-years or quality-adjusted life-years (QALYs), the authors documented cost equipoise between the open and endovascular repair groups. An examination of total health care costs also did not differ significantly between the 2 groups ($142 745 for endovascular vs $153 533 for open repairs; P = .25). When specific costs were examined in detail, the initial cost of the procedures constituted nearly 40% of the total cost and did not differ by repair type. Finally, using bootstrap analysis, the authors documented the probability that endovascular repair was less costly and more effective was 56.8% when measured in mean life-years and 55.4% when measured in QALYs.

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