Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Br J Surg. 2024 Jan 3;111(1). doi: 10.1093/bjs/znad378.
Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up.
A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged ≥18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken. A multicentre prospective cost analysis of patients (recruited March 2014-July 2018, follow-up until July 2019) undergoing TEVAR or OSR was performed. Patients deemed suitable for open or endovascular repair were included in this study. A micro-costing approach was adopted.
Some 115 patients having undergone TEVAR and 35 patients with OSR were identified. The mean (s.d.) cost of a TEVAR procedure was higher £26 536 (£9877) versus OSR £17 239 (£8043). Postoperative costs until discharge were lower for TEVAR £7484 (£7848) versus OSR £28 636 (£23 083). Therefore, total NHS costs from admission to discharge were lower for TEVAR £34 020 (£14 301), versus OSR £45 875 (£43 023). However, mean NHS costs for 12 months following the procedure were slightly higher for the TEVAR £5206 (£11 585) versus OSR £5039 (£11 994).
Surgical procedure costs were higher for TEVAR due to device costs. Total in-hospital costs were higher for OSR due to longer hospital and critical care stay. Follow-up costs over 12 months were slightly higher for TEVAR due to hospital readmissions.
胸主动脉瘤的治疗包括血管内修复（TEVAR）或开放手术修复（OSR），这两种治疗均为大手术，费用高昂，且伴有严重的并发症。本研究旨在确定一组适合开放和血管内治疗的英国国民保健服务（NHS）患者的 TEVAR 和 OSR 治疗总费用，包括从入院到出院及 12 个月随访的全过程。
在英格兰 30 个 NHS 血管/心胸外科中心开展了一项针对年龄≥18 岁、有远端弓/降主动脉夹层动脉瘤（CTAA）的英国 NHS 患者的前瞻性研究。对 2014 年 3 月至 2018 年 7 月期间接受 TEVAR 或 OSR 治疗的患者（随访至 2019 年 7 月）进行了一项多中心前瞻性成本分析。本研究纳入了适合开放或血管内修复的患者。采用微观成本法。
共确定了 115 例行 TEVAR 治疗的患者和 35 例行 OSR 治疗的患者。TEVAR 手术的平均（标准差）费用为£26536（£9877），高于 OSR 的£17239（£8043）。TEVAR 术后直到出院的费用较低，为£7484（£7848），而 OSR 为£28636（£23083）。因此，从入院到出院的 NHS 总费用，TEVAR 为£34020（£14301），低于 OSR 的£45875（£43023）。然而，TEVAR 术后 12 个月的 NHS 平均费用略高，为£5206（£11585），而 OSR 为£5039（£11994）。
由于设备费用，TEVAR 的手术费用较高。由于住院和重症监护时间较长，OSR 的总住院费用较高。由于需要再次住院，TEVAR 的 12 个月随访费用略高。
