Optimization of the EVAR Pathway: An Integrated Organizational Model for Clinical Efficiency and Economic Sustainability
Author(s)
Elisa Tacconi, Eng1, Gaia Maria Luna Maglionico, MSc2, Raffaello Bellosta, MD3.
1Sr. Value, Access & Policy Consultant, Medtronic Italia, Milano, Italy, 2Medtronic Italia, Milan, Italy, 3Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
1Sr. Value, Access & Policy Consultant, Medtronic Italia, Milano, Italy, 2Medtronic Italia, Milan, Italy, 3Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
OBJECTIVES: In a national context marked by significant heterogeneity in the hospital management of endovascular abdominal aortic aneurysm repair (EVAR), this analysis explores the organizational and economic impact of an optimized model based on digitalization, the presence of a dedicated ward physician, and continuity of clinical care.
METHODS: A structured survey was conducted at a best-practice center in Northern Italy to reconstruct the EVAR pathway across all phases: pre-hospitalization, hospitalization, operating room, post-operative care, and follow-up. Data were collected on timing, professional resources, and digital tool use.
RESULTS: The EVAR pathway is supported by an integrated care pathway, electronic medical records, and a dedicated ward physician. This model ensures continuity in decision-making and mitigates inefficiencies such as delays, redundant tests, and extended stays.
Pre-hospitalization lasts 2 to 4 hours, including comprehensive cardiological and routine exams, with two professionals involved. The total hospital stay is three days (one pre-operative, two post-operative).
Compared to the national average length of stay (3.5 days), this model reduces hospitalization by 0.5 days per patient, with a cost saving of €230 (daily cost: €459.52). Over the last three years, 77% of AAA cases at the center were treated with EVAR, generating cumulative savings of ~€55,200.
Extrapolating this EVAR rate to the 8,949 aneurysm repairs recorded nationally in 2023 suggests potential savings of ~€1.58 million.
Follow-up is scheduled at discharge, with over 90% adherence; this minimizes delayed access, reduces adverse events, and ensures continuity of care.
CONCLUSIONS: Implementing optimized organizational pathways for EVAR, as exemplified by the analyzed model, offers a concrete opportunity to improve clinical and operational efficiency, free up hospital resources, and increase capacity without additional investment. The broader adoption of structured, integrated models—based on digitalization, clinical pathways (PDTA), and continuity of care—may help align centers with higher standards, promoting greater equity and sustainability in AAA management.
METHODS: A structured survey was conducted at a best-practice center in Northern Italy to reconstruct the EVAR pathway across all phases: pre-hospitalization, hospitalization, operating room, post-operative care, and follow-up. Data were collected on timing, professional resources, and digital tool use.
RESULTS: The EVAR pathway is supported by an integrated care pathway, electronic medical records, and a dedicated ward physician. This model ensures continuity in decision-making and mitigates inefficiencies such as delays, redundant tests, and extended stays.
Pre-hospitalization lasts 2 to 4 hours, including comprehensive cardiological and routine exams, with two professionals involved. The total hospital stay is three days (one pre-operative, two post-operative).
Compared to the national average length of stay (3.5 days), this model reduces hospitalization by 0.5 days per patient, with a cost saving of €230 (daily cost: €459.52). Over the last three years, 77% of AAA cases at the center were treated with EVAR, generating cumulative savings of ~€55,200.
Extrapolating this EVAR rate to the 8,949 aneurysm repairs recorded nationally in 2023 suggests potential savings of ~€1.58 million.
Follow-up is scheduled at discharge, with over 90% adherence; this minimizes delayed access, reduces adverse events, and ensures continuity of care.
CONCLUSIONS: Implementing optimized organizational pathways for EVAR, as exemplified by the analyzed model, offers a concrete opportunity to improve clinical and operational efficiency, free up hospital resources, and increase capacity without additional investment. The broader adoption of structured, integrated models—based on digitalization, clinical pathways (PDTA), and continuity of care—may help align centers with higher standards, promoting greater equity and sustainability in AAA management.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE599
Topic
Economic Evaluation, Organizational Practices, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)