OBJECTIVES: We examined predictors of high cost for abdominal aortic aneurysm (AAA) repair in order to identify patients who are likely to require more intensive treatments. In general, younger, healthier patients with unfavorable anatomy are good candidates for Open AAA repair while older patients with significant comorbidities and favorable anatomy have better results when treated with the less invasive endovascular aneurysm repair (EVAR) procedure. Indeed, a sizable number of patients present with AAA who could be treated safely following either modality. METHODS: A dataset of elective AAA repairs totaling 389 Fletcher Allen Health Care patients (230 EVAR, 159 OPEN) was analyzed retrospectively over the time period January 1, 2003 through December 31, 2011. Direct and indirect costs were obtained along with length of stay (LOS) and other clinical and behavioral parameters. Models to predict being in the upper quartile of cost were developed using logistic regression. RESULTS: Significant predictors of being in the upper quartile of costs for Open patients were history of treated COPD, previous bypass surgery, transfer from hospital, and age > 70, with area under ROC = 0.726. Predictors for EVAR patients were presence of iliac aneurysm(s), CABG/PTCA within the past 5 years, ejection fraction ≤ 30%, on beta blocker, creatinine ≥ 1.5mg/dl, and current smoker, with area under ROC = 0.784. For EVAR patients, who had an average LOS of only 1-2 days, total costs ranged from $21,904 to $47,511. For Open patients, who had an average LOS of 5-7 days, these figures ranged from $13,549 to $35,685 in constant dollars. CONCLUSIONS: This wide range of total cost invites the introduction of resource utilization tools based on cost predictors that can optimize clinical outcomes and reduce costs at the individual patient level.