Cost-Effectiveness of Endovascular vs. Open Surgery for Abdominal Aortic Aneurysms: A Study Based on Medicare Public Data

Purpose: Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open surgical repair for abdominal aortic aneurysms (AAA). Its cost-effectiveness compared to open repair, particularly over the long term, remains a subject of debate. To compare the cost-effectiveness of EVAR and open surgery for AAA using publicly available Medicare claims data.

Materials and Methods: Analysis of Medicare claims data from 2010 to 2020, encompassing AAA repairs (EVAR and open surgeries), was conducted. Costs were measured as total procedural, hospital, and follow-up expenses over a 5-year period. Long-term survival, reintervention rates, and quality-adjusted life years (QALYs) were calculated to assess cost-effectiveness.

Results: EVAR had lower initial hospital costs ($22,000 vs. $32,500 for open surgery, p < 0.001) and a shorter length of stay (2.3 vs. 7.1 days, p < 0.001). However, over 5 years, 17% of EVAR patients required reintervention, compared to only 5% of open surgery patients (p < 0.01). The total 5-year cost was $43,000 for EVAR and $47,500 for open surgery. EVAR patients had slightly higher QALYs (4.1 vs. 3.9), indicating a modest long-term benefit.

Conclusion: EVAR offers cost benefits and faster recovery in the short term but incurs higher reintervention rates, resulting in similar overall 5-year costs to open surgery. Patient selection should be based on individual risk profiles, particularly for long-term success.