1. Long-term Cost-effectiveness in the Veterans Affairs Open vs Endovascular Repair Study of Aortic Abdominal Aneurysm
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Hosam Farouk El Sayed, Cinda Sobotta, Reba Jones, Kellie R. Brown, Henry M. Baraniewski, Amanda J. Snodgrass, C. Keith Ozaki, Fred N. Littooy, Roderick A. Barke, Christian De Virgillio, Richard J. Massen, Anne S. Irwin, Gregory L. Moneta, George Pisimisis, Sister Frances Randall, Sheila M. Coogan, Joseph S. Giglia, Caron Rockman, Richard L. McCann, David Whitley, Erika R. Ketteler, Jeffrey H. Lawson, Matthew W. Mell, John L. Gray, Angela G. Vouyouka, Howard Greisler, Roy M. Fujitani, John W. Hallett, James M. Goff, Kathleen Hickson, Elizabeth Latts, Claudia Yales, Margaret Antonelli, Mina Behdad, Andrea M. Escalante, Karen Chong, Stephen M. Kubaska, Jorge Lopez, Joseph J. Cullen, Glenn C. Hunter, Brenda J. Jasper, John M. Marek, Kimberly Yan, Dennis F. Bandyk, June Poulton, Thomas S. Burdick, Bassem Safadi, Richard J. Gusberg, Sally Reinhardt, Erik Owens, Randy Baum, Robert J. Guerra, Laura Ashe, Mary T. O'Sullivan, Edward Perry, Michael A. Golden, Lynn Durant, Peter H. Lin, Margaret L. Schwarze, Jennifer Poirier, Jessie M. Jean-Claude, Jane Guidot, J. David Pitcher, Elaine O'Brien, Steven J. Busuttil, Stephanie Ross, Darra D. Kingsley, Vicki Bishop, Anna Busman, Kathleen M. Swanson, Rebecca L. Reinhard, Scott Zellner, Beth A. Forbes, John L. Mills, Carmelene Joncas, Georgia Purviance, Theodore Karrison, Sherilyn Pillack, Christine Maagas, Mark Langsfeld, Nancy Oberle, Stephen G. Lalka, Clair M. Haakenson, Carlos F. Bechara, Scott A. Berceli, Murray L. Shames, Michelle A. Bhola, Mary Le Gwin, Anna Rockich, Stephen P. Johnson, Robert W. Zickler, Julie A. Freischlag, John P. Matts, Heather G. Allore, Christian Bianchi, Bernadette Aulivola, Terry O'Connor, Richard A. Yeager, Brad Johnson, Ronald M. Fairman, John F. Eidt, Melita Braganza, Alice Kossack, Rajni Mehta, Bauer E. Sumpio, David Minion, Joseph H. Rapp, Brajesh K. Lal, Michelle Endo, Jon S. Matsumura, Iraklis I. Pipinos, Melanie Estes, Girma Tefera, Mitzi Rusomaroff, Gregory J. Landry, John R. Hoch, Cindy Inman, Janice Rieder, Loretta Cole, Gary Lemmon, Shemuel B. Psalms, James M. Edwards, Ted R. Kohler, Peter R. Nelson, David A. Katz, Hugh A. Gelabert, James Ebaugh, Brian D. Lewis, Nancy N. Day, Nikhil Kansal, Glenn R. Jacobowitz, Ruth L. Bush, Reverend Michael Zeman, Sandra M. Walsh, Jill Warner-Carpenter, Catherine Cagiannos, Mark R. Nehler, Carlos H. Timaran, Prakash Chand, Leah J. Caropolo, Ling Ge, Shirley Joyner, Karen Eschberger, Mohammed Moursi, Michael P. Lilly, Susan Framberg, Christa Kallio, Robyn A. Macsata, Barbara Salabsky, Charles W. Acher, Frank A. Lederle, Jason M. Johanning, Tammy Nguyen, Gerald Treiman, Ian L. Gordon, Deanna Maples, Catherine Proebstle, Joy Kimbrough, William Farrell, Satish Muluk, Gilles Pinault, Beth Dunlap, Sandra C. Carr, William D. Jordan, Erin Olgren, Thomas A. Whitehill, Donald Beckwith, Peter Guarino, Lloyd M. Taylor, Wendy Meadows, Vanessa McBride, Subodh Arora, James Niederman, E. Lynne Kelly, Jonathan Weiswasser, David G. Glickerman, Gene Guinn, Pamela Strecker, Bart E. Muhs, Eleanor Cannady, Heron E. Rodriguez, Christopher Owens, Karen L. Wilson, Shawna Thunen, Elizabeth Davis, Stanislav V. Kasl, Shelley S. Dwyer, Julie Thornton, Maria Foster, Vickie Beach, Doghdoo D. Bahmani, Penny Vasilas, Luis R. Leon, Matthew Nalbandian, Reza Azadegan, Diane C. Robertson, Richard A. Marottoli, Ross Milner, John M. Stuart, David A. Rigberg, Nina M. Peterson, Mary Evans, David Chew, Subhash Lathi, Nadine White, Macario Riveros, Jeffrey Pollak, Timothy J. O'Leary, Yvonne Jonk, Frank T. Padberg, Richard Feldman, Stephanie Hatton-Ward, J. Gregory Modrall, Paul J. Gagne, James Wong, Kimberly Pedersen, Norman Hertzer, Brian D. Matteson, Wei Zhou, Nina Lee, Mark W. Sebastian, Steven M. Santilli, William C. Krupski, Neal Cayne, Anton N. Sidawy, Neal R. Barshes, Christina Paap, Sherry M. Wren, Alex Westerband, Sandra Brock, Vivian Gahtan, John D. Hughes, Panagiotis Kougias, Jonathan B. Towne, Michael Ranella, W. Anthony Lee, Ryan Nachreiner, Cynthia K. Shortell, Patricia A. Prinzo, Kea Ellis, Ronald L. Dalman, Thomas G. Lynch, Karthikeshwar Kasirajan, H. Edward Garrett, Joaquim J. Cerveira, Peter Peduzzi, Marcelo Spector, Carla Blackwell, Omran Abul-Khoudoud, Dolores F. Cikrit, Jean Kistler Tetterton, Martin Back, Darrell N. Jones, Darryl S. Weiman, Donna Kerns, Mark Wilson, Preet Kang, Kenneth Granke, Gary R. Johnson, Linda M. Reilly, Marilyn Bader, Lauri Lee Johnson, Ravi K. Veeraswamy, Sandra L. Perez, W. John Sharp, Gary R. Seabrook, Karthnik Kasirajan, Brenda Allende, John D. Corson, Kathy Zalecki, Joseph D. Raffetto, Thomas H. Schwarcz, Mark A. Patterson, Matthew Eiseman, John K.Y. Chacko, Mark Adelman, Holly De Spiegelaere, Alan Dardik, Madeline Ruf, Kevin T. Stroupe, Grant D. Huang, M. Burress Welborn, Alexandre C. D'Audiffret, Rajaabrata Sarkar, Michael Sobel, Steve M. Taylor, Barbara Guillory, Sandra C. Thomas, Thomas S. Hatsukami, Robert A. Cambria, Jeanne L. McCandless, Susan Stratton, Cindy Cushing, Karen A. Hauck, Atef Salam, Melina R. Kibbe, Tassos C. Kyriakides, Amy B. Reed, Jason T. Lee, Jamal J. Hoballah, Marc E. Mitchell, Hasan H. Dosluoglu, Marc A. Passman, Edith Tzeng, Patricia Cleary, and John Aruny
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Diagnostic Imaging ,Male ,medicine.medical_specialty ,Time Factors ,Cost effectiveness ,Cost-Benefit Analysis ,Comparative effectiveness research ,030204 cardiovascular system & hematology ,030230 surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,cardiovascular diseases ,Veterans Affairs ,health care economics and organizations ,Aged ,Intention-to-treat analysis ,business.industry ,Endovascular Procedures ,Health Care Costs ,Length of Stay ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Quality-adjusted life year ,Surgery ,Elective Surgical Procedures ,Quality of Life ,Health Resources ,Female ,Quality-Adjusted Life Years ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies ,Abdominal surgery - Abstract
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
- Published
- 2016
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