Life expectancy after endovascular versus open abdominal aortic aneurysm repair: Results of a decision analysis model on the basis of data from EUROSTAR

Background/Objectives: Although endovascular abdominal aortic aneurysm (AAA) repair (ENDO) has decreased operative morbidity risks compared with open AAA repair (OPEN), risks of rupture and reintervention are higher after ENDO. We used decision analysis to examine the effect of these competing risks...

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Bibliographic Details
Published in:Journal of vascular surgery 2002-12, Vol.36 (6), p.1112-1120
Main Authors: Schermerhorn, Marc L., Finlayson, Samuel R.G., Fillinger, Mark F., Buth, Jacob, van Marrewijk, Corine, Cronenwett, Jack L.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Databases as Topic - statistics & numerical data
Decision Support Techniques
Diseases of the aorta
Europe
Female
Humans
Life Expectancy
Male
Medical sciences
Middle Aged
Postoperative Complications
Quality-Adjusted Life Years
Survival Rate
Vascular Surgical Procedures - adverse effects
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Summary:Background/Objectives: Although endovascular abdominal aortic aneurysm (AAA) repair (ENDO) has decreased operative morbidity risks compared with open AAA repair (OPEN), risks of rupture and reintervention are higher after ENDO. We used decision analysis to examine the effect of these competing risks on quality-adjusted life expectancy (QALE) after ENDO and OPEN. Methods: We used a Markov decision-analysis model to simulate hypothetic cohorts of patients undergoing ENDO or OPEN. Patients moved through a multistate transition model according to probabilities derived from the literature, the EUROSTAR database (for ENDO) and Medicare claims data (for OPEN). Our primary outcome measure was QALE after surgery. We used sensitivity analysis to determine which factors most influenced this outcome. Results: In the base-case analysis of 70-year-old men, life expectancy after ENDO was 7.09 quality-adjusted life years compared with 7.03 quality-adjusted life years for OPEN, a difference of 3 weeks. Sensitivity analysis showed that at less than age 64 years, OPEN results in greater QALE. However, the difference in QALE was small (
ISSN:0741-5214
1097-6809
DOI:10.1067/mva.2002.129646