Cost-effectiveness analysis of chimney/snorkel versus fenestrated endovascular repair for high-risk patients with complex abdominal aortic pathologies.

Abstract

INTRODUCTION The aim of this study was to evaluate the cost-effectiveness of chimney(ch-EVAR) vs fenestrated(f-EVAR) aneurysm repair for treatment of complex abdominal aortic pathologies. Endovascular repair of complex abdominal aortic pathologies with involvement of renal arteries includes use of f-EVAR as first line treatment. However, lack of availability and suitability has necessitated an alternative strategy employing parallel or snorkel/chimney grafts (ch-EVAR). EVIDENCE ACQUISITION Between January 2013 and January 2017, prospectively collected data of elective and symptomatic patients with complex aortic pathologies treated by single or double ch-EVAR(n=111) or by f-EVAR with 3-fenestrations(n=37) were evaluated. The primary endpoint was cost-effectiveness analysis defined as the summary of material costs, in-hospital costs and additional costs due to procedure-related reinterventions during a follow-up period averaging 37.2 months. EVIDENCE SYNTHESIS No differences between both groups were found in terms of demographics (p=.32), age (p=.058) and hospital stay at initial procedure (p=.956). Index procedure and hospitalization median costs were 22.171€ for ch-EVAR and 42.116€ for f-EVAR, respectively (p<.001). The median overall costs including costs after reinterventions during follow-up were 22.872€ for ch-EVAR and 42.128€for f-EVAR (p<.001). Six patients (5.4%) in the ch-EVAR group required readmission compared to 3 patients (8,1%) required readmission for reinterventions in the f-EVAR group (p=.69). CONCLUSIONS Ch-EVAR is significantly more cost-effective compared to f-EVAR. The two procedures have comparable readmission rates for reinterventions.