2007 Abstracts: Long-Term Follow-Up Cost After Endovascular Aneurysm Repair

Background: Previous studies have demonstrated that the initial hospital cost associated with endovascular aneurysm repair (EVAR) is approximately $20,000. However, cost of long-term surveillance and secondary procedures is poorly characterized.
Methods: Two-hundred and forty-eight patients underwent EVAR for infrarenal aneurysms between December 1998 and June 2005. Patients with less than one year complete follow-up were excluded. Supply and service costs were calculated using allocation statistics developed at a departmental level, including all direct and indirect (overhead) costs. Costs for professional services were determined by a cost-to-charge ratio. 2006 cost codes were applied to prior years. Data are expressed as mean ± standard error (SE).
Results: One-hundred and thirty-six patients after EVAR had a mean follow-up of 35.4 ± 1.7 months. Twenty-seven patients underwent fifty secondary interventions at a mean of 25.6 ± 1.5 months.
Mean cost per patient per year of follow-up is shown.

*p value ≤ 0.001 vs. no secondary intervention group
Cumulative 5 year post-EVAR cost per patient was $11,636. Overall, major cost components were 58.2% secondary interventions and radiology 31.6%. Post-EVAR cost per patient was increased nine-fold ($34,642 vs. $3,683, p <0.0001) when secondary procedures were required.
Conclusions: The true cost of EVAR includes both the cost of the initial device placement plus the post-placement costs. Over a 5-year period, the post-placement cost of EVAR increases the global cost by approximately 50%. Efforts at minimizing cost should emphasize technical and device modifications aimed at reducing secondary interventions.