Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Sep 1;84(9):890-899. doi: 10.1097/JCMA.0000000000000581.
To investigate the cost-effectiveness of endovascular aortic repair (EVAR) versus open aortic repair (OAR) for abdominal aortic aneurysm (AAA) using incremental costs per decreased in-hospital mortality rate gained through our patients' cohort.
Medical records and healthcare costs of patients with AAA hospitalized between 2010 and 2015 were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Multiple regression analysis was applied to adjust for confounding factors and to compare the differences in postoperative clinical outcomes between patients who received EVAR and OAR. The incremental cost-effectiveness ratio (ICER) of EVAR was determined based on the healthcare cost obtained from the analyzed data.
A total of 2803 AAA patients were identified (n = 559 with ruptured AAA and n = 2244 unruptured AAA). Patients with ruptured AAA who underwent EVAR compared with OAR patients had shorter hospital and intensive care unit (ICU) stays (all p < 0.05). For patients with unruptured AAA, those who received EVAR compared with OAR, the adjusted odds ratio (aOR) of postoperative complications and in-hospital mortality were 0.371 and 0.447 (all p < 0.05). The total direct surgical costs and medical expenses during hospitalization in all AAA patients were higher for the EVAR group; however, ICER was <1 per capita gross domestic product. Stratification by age groups further suggested that ICER for patients with unruptured AAA who received EVAR, compared with OAR, decreased with age.
Total direct medical costs were higher for AAA patients receiving EVAR regardless of rupture status; however, the cost is offset by lower odds of postoperative complications and in-hospital mortality. The observed decrease in ICER with age and EVAR use warrants further analysis. Our findings further validate the use of EVAR over OAR. These results provides supporting evidence for physicians and patients with AAA to inform shared decision making regarding endovascular or OAR options.
本研究旨在通过对我院患者队列的分析，利用因院内死亡率降低而增加的增量成本，探讨血管内主动脉修复术（EVAR）与开放主动脉修复术（OAR）治疗腹主动脉瘤（AAA）的成本效益。
从台湾全民健康保险研究数据库（NHIRD）中提取了 2010 年至 2015 年期间住院治疗的 AAA 患者的病历和医疗费用。采用多元回归分析调整混杂因素，并比较接受 EVAR 和 OAR 治疗的患者术后临床结局的差异。根据分析数据得出的医疗成本，确定 EVAR 的增量成本效益比（ICER）。
共确定了 2803 例 AAA 患者（n = 559 例破裂性 AAA，n = 2244 例未破裂性 AAA）。与 OAR 患者相比，接受 EVAR 治疗的破裂性 AAA 患者的住院时间和重症监护病房（ICU）停留时间更短（均 P < 0.05）。对于未破裂性 AAA 患者，接受 EVAR 治疗的患者与 OAR 患者相比，术后并发症和院内死亡率的调整优势比（aOR）分别为 0.371 和 0.447（均 P < 0.05）。所有 AAA 患者的 EVAR 组的直接总手术费用和住院期间的医疗费用均较高；然而，ICER 低于人均国内生产总值。按年龄组分层进一步表明，与 OAR 相比，接受 EVAR 的未破裂性 AAA 患者的 ICER 随年龄的增长而降低。
无论破裂状态如何，接受 EVAR 的 AAA 患者的直接医疗总费用较高；然而，通过降低术后并发症和院内死亡率的几率，这一成本得以抵消。观察到的 ICER 随年龄和 EVAR 使用而降低需要进一步分析。我们的研究结果进一步验证了 EVAR 优于 OAR 的应用。这些结果为医生和 AAA 患者提供了支持性证据，有助于就血管内或 OAR 选择进行共同决策。
