OBJECTIVES : To describe endovascular treatment of AAA in France from national hospital claims database.

METHODS : All hospital stays associated with AAA endoprosthesis implantation were extracted from the 2014 database. Implant codes were used to group patients according to Endoprosthesis type into three arms: GORE® EXCLUDER® AAA Endoprosthesis (Group A), COOK® ZENITH® Endovascular System (Group B) and MEDTRONIC ENDURANT® Abdominal Stent Grafts or MEDTRONIC TALENT® Abdominal Stent Grafts (Group C). They were followed during three years from index procedure. With an algorithm and medical review of selected data, we excluded rehospitalizations unlikely to be endoprosthesis implantation-related. To create homogeneous cohorts, propensity score matching associating hospital status (public/private), DRG severity level and comorbidities at inclusion was used. Resources utilization were considered for both initial procedure and related rehospitalizations, from the national health insurance perspective.

RESULTS : In 2014, 916 patients in Group A, 1,239 in Group B and 1,503 in Group C were identified: 874 patients in each arm were matched. Patients were 73.8 ± 9.2 years old on average, 92.8% were men. DRG severity level in each cohort was level 1 in 50% of patients, level 2 in 40% and level 3 or 4 in 10%. Stay occurred in public hospitals in 57%. Mean length of stay was 6.7 ± 5.5 days for Group A, 7.0 ± 7.2 for Group B (p=0.0077) and 7.7 ± 7.6 for Group C (p<0.001). At 3 years, 47.5% Group A patients, 50% Group B patients and 48.3% Group C patients had at least one rehospitalization. The mean 3-year cost was €15,674 ± 10,542 per Group A patient versus €16,508 ± 12,992 per Group B patient and €16,226 ± 10,413 per Group C patient.

CONCLUSIONS : This is the first real-life analysis of the treatment of AAA by vascular endoprostheses in France performed by using hospital claims databases.