van Bochove Cornelis A, Burgers Laura T, Vahl Anco C, Birnie Erwin, van Schothorst Marien G, Redekop William K
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
J Vasc Surg. 2016 Mar;63(3):827-38.e2. doi: 10.1016/j.jvs.2015.10.055.
Patients with a large unruptured abdominal aortic aneurysm with a diameter >5.0 cm are treated with open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Because many studies have assessed the cost-effectiveness of these treatments with conflicting results, this systematic review examined published cost-effectiveness analyses of elective EVAR vs OSR in patients with abdominal aortic aneurysm.
A systematic search strategy using three databases was conducted to find all relevant studies. Characteristics extracted from these studies included study characteristics (eg, age of the population), input parameters (eg, costs of the EVAR procedure), general results, and sensitivity analyses. The quality of each study was assessed using the Drummond checklist.
The search identified 1141 potentially relevant studies, of which 13 studies met inclusion criteria. Most studies found that EVAR was more expensive and more effective than OSR. However, most studies concluded that the health gained from EVAR did not offset the higher total costs, leading to an unacceptably high incremental cost-effectiveness ratio. EVAR was considered more cost-effective in patient groups with a high surgical risk. The quality of most studies was judged as reasonably good.
Overall, published cost-effectiveness analyses of EVAR do not provide a clear answer about whether elective EVAR is a cost-effective solution because the incremental cost-effectiveness ratio varies considerably among the studies. This answer can best be provided through a cost-effectiveness analysis of EVAR that incorporates more recent technologic advances and the improved experience that clinicians have with EVAR.
直径>5.0 cm的大型未破裂腹主动脉瘤患者可采用开放手术修复（OSR）或血管内动脉瘤修复（EVAR）进行治疗。由于许多研究评估了这些治疗的成本效益，但结果相互矛盾，因此本系统评价考察了已发表的关于腹主动脉瘤患者选择性EVAR与OSR的成本效益分析。
采用三个数据库进行系统检索策略，以查找所有相关研究。从这些研究中提取的特征包括研究特征（如人群年龄）、输入参数（如EVAR手术成本）、一般结果和敏感性分析。每项研究的质量均使用德拉蒙德清单进行评估。
检索确定了1141项潜在相关研究，其中13项研究符合纳入标准。大多数研究发现，EVAR比OSR更昂贵且更有效。然而，大多数研究得出结论，EVAR带来的健康效益并未抵消更高的总成本，导致增量成本效益比高得令人无法接受。在手术风险高的患者群体中，EVAR被认为更具成本效益。大多数研究的质量被判定为相当好。
总体而言，已发表的EVAR成本效益分析并未就选择性EVAR是否是一种具有成本效益的解决方案给出明确答案，因为各研究之间的增量成本效益比差异很大。通过纳入更新技术进展和临床医生对EVAR的改进经验的EVAR成本效益分析，能够最好地给出这一答案。
