Systematic review and cost-effectiveness analysis of elective endovascular repair compared to open surgical repair of abdominal aortic aneurysms: Final report

Bowen J, De Rose G, Blackhouse G, Novick T, Hopkins R, Tarride J-E, Goeree R
Record ID 32008100108
English
Authors' objectives:

In 2003, the Ministry of Health and Long Term Care (MOHLTC) conducted a review of primary studies on endovascular repair (EVAR) for abdominal aortic aneurysms (AAA) as well as a review of previous international and Canadian Health Technology Assessments (HTA). Due to the informational uncertainty associated with the long-term effectiveness of EVAR, the MOHLTC recommended that an Ontario-specific evaluation of the technology was warranted. The MOHLTC provided funding on a one time basis to support a 24-
month EVAR evaluation at London Health Science Centre (LHSC) where the Ministry had received previous requests for funding. A condition of this funding was that LHSC would collaborate with the Program for Assessment and Technology in Health (PATH) at St. Joseph’s Healthcare Hamilton/McMaster University to design and conduct an observational study or “field evaluation” to support the assessment of the effectiveness and cost-effectiveness of EVAR as compared to open surgical repair (OSR) in Ontario.
The purpose of this research was threefold. First, to provide an evaluation of the scientific literature related to EVAR. Second, to collect Ontario-specific clinical, resource utilization and quality-of-life data related to the use of EVAR and OSR. And finally, to evaluate the cost-effectiveness of endovascular repair compared to open surgical repair for the management of non-ruptured AAA in Ontario.
In 2005, an interim report was provided to the MOHLTC and presented to the Ontario Health Technology Advisory Committee (OHTAC). This report contained an updated systematic literature review, an interim analysis of the “field evaluation” and an initial evaluation of the cost-effectiveness of EVAR versus OSR based on data from a subset of patients recruited into the LHSC study with 1 year follow-up. The purpose of this report is to provide an update on the systematic literature review and report the final findings of the field evaluation
and associated economic evaluation.

Authors' results and conclusions: The unique primary studies identified from this literature search, including studies previously identified in the interim evaluation and newly identified studies, consisted of 6 randomized controlled trials and 78 non-randomized trials comparing EVAR to OSR. Long-term patient outcomes (greater than 30 days post surgery) were reported in 33.3% (27/78) of the observational trials. The derivation of the outcomes from the SVS/AAVS reporting guidelines was not possible for all studies as the reporting of data was inconsistent from theidentified trials. Within the observational studies patients receiving EVAR were generally of a higher surgical baseline risk of mortality and complications.
Authors' recommendations: For patients at a high risk of surgical mortality and complications, EVAR is a safe effective and cost-effective procedure with fewer complications and mortality occurring in EVAR patients compared to OSR patients with similar baseline risk. Reintervention for the management of endoleaks or endograft failure was not required. The total initial hospitalization costs associated with EVAR compared to OSR HR were lower and differences in the mean total annual 1 year costs were negligible.
Authors' methods: Systematic review
Details
Project Status: Completed
URL for project: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/techlist_mn.html
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Angioplasty
  • Review Literature as Topic
  • Elective Surgical Procedures
  • Vascular Surgical Procedures
  • Cost-Benefit Analysis
  • Aortic Aneurysm, Abdominal
  • Surgical Procedures, Operative
Contact
Organisation Name: Medical Advisory Secretariat
Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;
Contact Name: MASinfo.moh@ontario.ca
Contact Email: MASinfo.moh@ontario.ca
Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care (MAS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.