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Cost, Reintervention, and Potential Savings for Endovascular Aortic Aneurysm Repair
Suniah S. Ayub, MD, MPH1, Salvatore Scali, MD1, David K. Bielick, MS1, Adam W. Beck, MD2, Julie A. Richter, MBA1, Thomas S. Huber, MD, PhD1, Javairiah Fatima, MD1, Philip P. Goodney, MD, MS3, Kristina A. Giles, MD1.
1University of Florida, Gainesville, FL, USA, 2University of Alabama, Birmingham, AL, USA, 3Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

Objective: Previous EVAR cost analyses have found low profit margins, attributable to inadequate reimbursement and high graft costs. This study’s objective is to discern the relationship between endograft brand, hospitalization costs, and associated reinterventions. We explored potential cost savings by reassigning patients who met anatomic criteria(IFU) for all four endografts to the least costly graft.
Methods: All nonruptured EVAR procedures performed from December 2010 to October 2015 in a single-institution clinical database were reviewed. Procedures involving the most recent generation of the four highest market share graft devices were included. Data included endograft brand, hospitalization cost, endograft cost, inpatient complications, 30-day mortality, length of follow up, long-term reinterventions, and reintervention cost. Pre-operative patient anatomy was reviewed for fulfillment of IFUs for all four graft brands in this study. Patients who could fulfill all four IFUs were standardized to the lowest cost endograft and potential cost savings were calculated.
Results: After review, 104 patients met inclusion criteria. The four brands of endograft were Graft A(n=78), B(n=10), C(n=9), and D(n=7). Mean preoperative AAA diameter was 56.16mm and did not differ significantly between brands. Incidence of femoral cutdown, LOS, ICU days, inpatient complications, and inpatient mortality did not differ significantly between brands. Hospitalization cost did not differ significantly between brands(P=0.146). However, the lowest endograft cost was Graft C(P<0.0001) with a variation of $6705.26 between the lowest and highest cost grafts. Average length of followup was 581.82 days, which differed significantly between brands(P=0.0093). Freedom from reintervention at 1 year was 92% for all patients with a standard error of 0.0299. Reintervention costs did not differ significantly across brands(P=0.6304). Eighty-eight patients(84.6%) met IFUs for all four brands(72A, 9B, 3C, 4D). Endograft cost differed significantly between these patients and the lowest cost endograft in the analysis, Graft C(P<0.0001). Potential cost savings with standardization to Graft C was $180,238.96.

Conclusions: While factors other than graft cost affect surgeon and institution use of specific graft types, when standardizing anatomy we find potential cost savings if the most inexpensive graft is chosen without sacrificing outcome. Awareness of device cost may help to realize cost savings within an institution.

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