UNDERSTANDING STAKEHOLDER PERSPECTIVES BETWEEN ENDOVASCULAR AND HYBRID REPAIR FOR THORACIC AORTIC ANEURYSMS AND DISSECTIONS INVOLVING THE LEFT SUBCLAVIAN ARTERY
Author(s)
Mitesh Nakum, MPharm MSc1, Anne Krohmer Marti, MS2.
1EMEA Health Economist, W.L. Gore & Associates, Scotland, United Kingdom, 2W.L. Gore & Associates, Elkton, MD, USA.
1EMEA Health Economist, W.L. Gore & Associates, Scotland, United Kingdom, 2W.L. Gore & Associates, Elkton, MD, USA.
OBJECTIVES: This qualitative study aimed to explore the preferences of physicians, hospital providers and patients when choosing between endovascular and hybrid repair approaches for thoracic aortic aneurysms (TAA) and thoracic aortic dissections (TAD) involving the left subclavian artery (LSA). The objective was to explore how stakeholders evaluate procedure-related attributes and trade-offs they are willing to make between benefits and risks.
METHODS: Semi-structured, 60-minute interviews were conducted with physicians (n=20), providers (n=18) and patients (n=14) across the U.S., U.K., Germany and Italy. Patients were eligible if they had experience with endovascular or hybrid thoracic aortic repair procedures involving zone 2 and the LSA. Interviews included open-ended concept elicitation and a structured mock choice task presenting hypothetical repair options with varying attributes (eg, invasiveness, stroke risk, number of procedures and recovery time). Interview data were analysed to identify key themes, using both pre-defined topics and new ideas that emerged from participants' responses.
RESULTS: Physicians favoured endovascular repair for its reduced invasiveness, location and need for incisions, shorter recovery time, and the ability to complete repair in a single stage. Disabling stroke was the most common concerning risk with both approaches, while endovascular-specific concerns included stent-related complications. Providers preferred procedures that reduced inpatient stay, operating room time and hospital resource use, and placed high importance on reimbursement compatibility. Patients expressed preferences for single, minimally invasive procedures without neck incisions. Stroke and paralysis were top concerns; cosmetic outcomes were less influential. Across all groups, endovascular repair was generally preferred when trade-offs were presented.
CONCLUSIONS: In this qualitative sample, participants described varying perceptions of risks and benefits, with many expressing a preference for endovascular repair when discussing the repair options with their attributes and trade-offs, emphasizing advantages related to clinical effectiveness, procedural efficiency and patient-centered care.
METHODS: Semi-structured, 60-minute interviews were conducted with physicians (n=20), providers (n=18) and patients (n=14) across the U.S., U.K., Germany and Italy. Patients were eligible if they had experience with endovascular or hybrid thoracic aortic repair procedures involving zone 2 and the LSA. Interviews included open-ended concept elicitation and a structured mock choice task presenting hypothetical repair options with varying attributes (eg, invasiveness, stroke risk, number of procedures and recovery time). Interview data were analysed to identify key themes, using both pre-defined topics and new ideas that emerged from participants' responses.
RESULTS: Physicians favoured endovascular repair for its reduced invasiveness, location and need for incisions, shorter recovery time, and the ability to complete repair in a single stage. Disabling stroke was the most common concerning risk with both approaches, while endovascular-specific concerns included stent-related complications. Providers preferred procedures that reduced inpatient stay, operating room time and hospital resource use, and placed high importance on reimbursement compatibility. Patients expressed preferences for single, minimally invasive procedures without neck incisions. Stroke and paralysis were top concerns; cosmetic outcomes were less influential. Across all groups, endovascular repair was generally preferred when trade-offs were presented.
CONCLUSIONS: In this qualitative sample, participants described varying perceptions of risks and benefits, with many expressing a preference for endovascular repair when discussing the repair options with their attributes and trade-offs, emphasizing advantages related to clinical effectiveness, procedural efficiency and patient-centered care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MT38
Topic
Medical Technologies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas