The cost of surgical and endovascular treatment of abdominal aortic aneurysm – a retrospective comparative study

Summary

Introduction:
A comparison of the costs of a surgery and an endovascular treatment of abdominal aortic aneurysms (AAA) for the General Health Insurance Company (VšZP) in 2009–2010.

Material and methods:
Between 2009 and 2010, VšZP paid for treatment of 211 patients with AAA with an average age of 69 years (range: 41–91 years). Out of these, 174 patients underwent surgical treatment and 37 patients were treated by endovascular means. In both groups, we observed a total cost of treatment, payment for hospitalization (UH) and separately charged material (ZM), the cost of blood and reimbursement for CT (computer tomography) examinations and the patient age. For statistical comparison, we used the nonparametric Mann-Whitney U test, the limit of statistical significance was <0.01. The data were processed and compared by means of contingency tables in MS Excel and then statistically processed in the program StatSoft, Inc.. (2011). STATISTICA (data analysis software system), version 10th www.statsoft.com.

Results:
The total two-year costs of VšZP for the treatment of AAA were € 1 212 188 – out of which 37% were represented by the OR costs (open repair) and 63% for EVAR (endovascular aneurysm repair) (p <0.01). In terms of the ZM use (p <0.01), and the use of CT examinations (p <0.01), EVAR is cost demanding. OR is cost demanding in terms of the blood consumption levels (p <0.01). The average total cost per admission was € 21,038 for EVAR and € 2,493 for OR, representing only 12% of the total EVAR costs. The age of patients has no impact on the costs (p> 0.01). The decisive impact on the total costs is represented by ZM, which presents 90 % of costs of EVAR method and 44% of OR method.

Conclusion:
OR and EVAR are effective modalities for the treatment of AAA. EVAR is a minimally invasive method, but the treatment costs are more than 8 times higher than the costs of surgical treatment. In terms of the VšZP cost control for the treatment of AAA, there must be clearly defined explicit indication criteria for EVAR. In terms of the costs for the treatment of AAA with “good risk” patients and those cases where there are no local obstacles for the surgical treatment (eg, colostoma, hostile abdomen, ren arcuatus and other), the surgical therapy is a “gold” standard. The health insurance company is a crucial regulator of the system of payment for provided medical care. The development of medical technology and the financial burden, on one hand, and the limited and scarce resources, on the other hand, are a source of “tension” between the health care providers and the regulators (insurance, Ministry of Health). One way to slow the “opening of the scissors” is to establish clear rules for the entry of new technologies into clinical practice, clearly defined costs (COI – cost of illness), and the usefulness and cost-effectiveness (CEA – cost-effectiveness analysis, ICER – incremental cost-effectiveness ratio, QALY – quality-adjusted life year). Despite the fact that it has beenmore than 20 years after the “velvet revolution”, implementing the principles of health economics and health technology into practice has been managed in a rather weak way. The comparison of the costs of treatment is applicable in many areas of clinical medicine, and in the case of well-defined data it can be a source for the determination of ICER, CEA and QALYs.

Key words:
abdominal aortic aneurysms – surgery and endovascular treatment – costs