Clinical and Economic Benefits of Branched Endovascular Stent Grafting for Intact Thoracoabdominal Aortic Aneurysm Repair: A Real-World Data Analysis
Author(s)
Sukgu M. Han, MD, MS, DFSVS1, Jeffrey D. Miller, MS2, Bismark Baidoo, PhD3, Ishani Mathur, MPH4, Sarah J. Leung, PhD4, George N. Foutrakis, MS2;
1Keck Medicine of USC, Division of Vascular Surgery and Endovascular Therapy, Los Angeles, CA, USA, 2W. L. Gore & Associates, Elkton, MD, USA, 3W. L. Gore & Associates, Phoenix, AZ, USA, 4W. L. Gore & Associates, Flagstaff, AZ, USA
1Keck Medicine of USC, Division of Vascular Surgery and Endovascular Therapy, Los Angeles, CA, USA, 2W. L. Gore & Associates, Elkton, MD, USA, 3W. L. Gore & Associates, Phoenix, AZ, USA, 4W. L. Gore & Associates, Flagstaff, AZ, USA
Presentation Documents
OBJECTIVES: Endovascular technology advancements allow minimally invasive treatment of thoracoabdominal aortic aneurysm (TAAA) using a branched endovascular aortic repair (BEVAR) technique. Wider adoption of BEVAR has been tempered by concerns regarding higher implant cost than open aortic repair (OAR). However, data on the overall economic impact of clinical outcomes of BEVAR vs. OAR in TAAA are sparse. This study aimed to evaluate the current clinical and economic outcomes of BEVAR vs. OAR for intact TAAA.
METHODS: Real-world, hospital-discharge data of patients undergoing intact TAAA repair in the U.S. from the PINC AI Healthcare Database (2020-2023) were analyzed. Patients were divided into two cohorts: BEVAR and OAR. Patient characteristics, clinical outcomes, complications, rehospitalization/reintervention and cost of index hospitalization were compared.
RESULTS: 466 patients who underwent TAAA repairs were included (160 BEVAR vs. 306 OAR). BEVAR patients were older (70.5 vs. 62.4 years, P<.0001), less likely to die during hospitalization (7.5% vs. 18.3%; P<.002) and more likely to be discharged home (78.1% vs. 56.9%; P<.0001). BEVAR patients also had lower Elixhauser comorbidity score (P<.0001), shorter hospitalization by 12.7 days (P<.0001) and shorter operating time by 228 minutes (P<.0001). Postoperatively, BEVAR patients had fewer major adverse events (75.0% vs. 85.3%, P<.001). Disaggregated by hospital department, the higher central supply cost for BEVAR ($56,937 vs. $17,718; P<.0001) was offset by lower postoperative care cost, resulting in lower overall total hospital cost compared with OAR cost ($82,338 vs. $103,155; P<.003).
CONCLUSIONS: Real-world adoption of BEVAR was associated with significantly lower postoperative mortality and major adverse events, as well as a shorter length of stay compared to OAR. Despite higher central supply costs, BEVAR was linked to significantly lower total hospital costs. With the increasing availability of dedicated BEVAR devices, endovascular TAAA repair presents a promising opportunity for improved patient care with potential cost savings.
METHODS: Real-world, hospital-discharge data of patients undergoing intact TAAA repair in the U.S. from the PINC AI Healthcare Database (2020-2023) were analyzed. Patients were divided into two cohorts: BEVAR and OAR. Patient characteristics, clinical outcomes, complications, rehospitalization/reintervention and cost of index hospitalization were compared.
RESULTS: 466 patients who underwent TAAA repairs were included (160 BEVAR vs. 306 OAR). BEVAR patients were older (70.5 vs. 62.4 years, P<.0001), less likely to die during hospitalization (7.5% vs. 18.3%; P<.002) and more likely to be discharged home (78.1% vs. 56.9%; P<.0001). BEVAR patients also had lower Elixhauser comorbidity score (P<.0001), shorter hospitalization by 12.7 days (P<.0001) and shorter operating time by 228 minutes (P<.0001). Postoperatively, BEVAR patients had fewer major adverse events (75.0% vs. 85.3%, P<.001). Disaggregated by hospital department, the higher central supply cost for BEVAR ($56,937 vs. $17,718; P<.0001) was offset by lower postoperative care cost, resulting in lower overall total hospital cost compared with OAR cost ($82,338 vs. $103,155; P<.003).
CONCLUSIONS: Real-world adoption of BEVAR was associated with significantly lower postoperative mortality and major adverse events, as well as a shorter length of stay compared to OAR. Despite higher central supply costs, BEVAR was linked to significantly lower total hospital costs. With the increasing availability of dedicated BEVAR devices, endovascular TAAA repair presents a promising opportunity for improved patient care with potential cost savings.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
MT3
Topic
Medical Technologies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), STA: Surgery