The vast majority of patients with abdominal aortic aneurysms (AAA) undergoing repairs receive endovascular interventions (EVARs) instead of open operations (OARs). While EVARs have better short-term outcomes, OARs have improved longer-term durability and require less radiographic follow-up and monitoring, which may have significant implications on healthcare economics surrounding provision of AAA care nationally. Herein, we compared costs associated with EVAR and OAR of both infrarenal and complex AAAs. We examined patients undergoing index elective EVARs or OARs of infrarenal and complex AAAs in the 2014-2019 VQI-VISION dataset. We defined overall costs as the aggregated longitudinal costs associated with (1) the index surgery, (2) reinterventions, and (3) imaging tests. We evaluated overall costs up to five years after infrarenal AAA repair and three years for complex AAAs repair. Multivariable regressions adjusted for case-mix when evaluating cost differences between EVARs vs. OARs. We identified 23,746 infrarenal AAA repairs (8.7% OAR, 91% EVAR) and 2,279 complex AAA repairs (69% OAR, 31% EVAR). In both cohorts, patients undergoing EVARs were more likely to be older and have more comorbidities. The cost for the index procedure for EVARs relative to OARs was lower for infrarenal AAAs ($32,440 vs. $37,488, P<.01) but higher among complex AAAs ($48,870 vs. $44,530, P<.01). EVARs had higher annual imaging and reintervention costs during each of the five postoperative years for infrarenal aneurysms and the three postoperative years for complex aneurysms. Among patients undergoing infrarenal AAA repairs who survived five years, the total five-year cost of EVARs was similar to those of OARs ($35,858 vs. $34,212; -$223 [-$3042 to $2596]). For complex AAA repairs, the total cost at three-years of EVARs was greater than OARs ($64,492 vs. $42,212; +$9860 [$5835 to $13885]). For patients receiving EVARs for complex aneurysms, PMEGs had higher index procedure costs ($55,835 vs. $47,064, P<.01) though similar total costs on adjusted analyses (+$1856 [-$7997 to $11,710], P=0.70) relative to ZFENs among those that were alive at 3-years. Longer-term costs associated with EVARs are lower for infrarenal AAAs but higher for complex AAAs relative to OARs, driven by reintervention and imaging costs. Further analyses to characterize the financial viability of EVARs for both infrarenal and complex AAAs should evaluate hospital margins and anticipated changes in costs of devices.

中文翻译：

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与肾下和复杂腹主动脉瘤的血管内和开放修复相关的长期医疗费用

绝大多数接受修复的腹主动脉瘤 (AAA) 患者接受血管内介入治疗 (EVAR)，而不是开放手术 (OAR)。虽然 EVAR 具有更好的短期结果，但 OAR 提高了长期耐久性，并且需要更少的放射学随访和监测，这可能对全国范围内提供 AAA 护理的医疗保健经济产生重大影响。在此，我们比较了肾下 AAA 和复杂 AAA 的 EVAR 和 OAR 相关成本。我们在 2014-2019 年 VQI-VISION 数据集中检查了接受肾下和复杂 AAA 指数选择性 EVAR 或 OAR 的患者。我们将总体成本定义为与（1）指数手术、（2）再干预和（3）影像学检查相关的纵向总成本。我们评估了肾下 AAA 修复后五年内的总成本以及复杂 AAA 修复后三年内的总成本。在评估 EVAR 与 OAR 之间的成本差异时，根据案例组合调整多变量回归。我们确定了 23,746 例肾下 AAA 修复（8.7% OAR，91% EVAR）和 2,279 例复杂 AAA 修复（69% OAR，31% EVAR）。在这两个队列中，接受 EVAR 的患者年龄更大且合并症更多。与 OAR 相比，肾下 AAA 的 EVAR 索引手术成本较低（32,440 美元 vs. 37,488 美元，P<.01），但复杂 AAA 的 EVAR 索引程序成本较高（48,870 美元 vs. 44,530 美元，P<.01）。肾下动脉瘤术后五年和复杂动脉瘤术后三年，EVAR 每年的影像学检查和再干预费用较高。在接受肾下 AAA 修复并存活五年的患者中，EVAR 的五年总成本与 OAR 相似（35,858 美元 vs. 34,212 美元；-223 美元 [-3042 美元至 2596 美元]）。对于复杂的 AAA 维修，三年 EVAR 的总成本高于 OAR（64,492 美元 vs. 42,212 美元；+9860 美元 [5835 美元至 13885 美元]）。对于接受 EVAR 治疗复杂动脉瘤的患者，PMEG 的手术指数较高（55,835 美元 vs. 47,064 美元，P<.01），尽管调整后的分析总成本与 ZFEN 相似（+1856 美元[-7997 美元至 11,710 美元]，P=0.70） 3岁时还活着的人。与 OAR 相比，肾下 AAA 与 EVAR 相关的长期成本较低，但复杂 AAA 的成本较高，这是由再干预和成像成本驱动的。进一步分析肾下和复杂 AAA 的 EVAR 的财务可行性，应评估医院利润和设备成本的预期变化。