Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
5-Year IF – 2.0, IF – 1.9, JCI (2024) – 0.43
Scopus CiteScore – 4.3
Q1 in SJR 2024, SJR score – 0.598, H-index: 49 (SJR)
ICV – 161.00; MNiSW – 70 pts
Initial editorial assessment and first decision within 24 h

ISSN 1899–5276 (print), ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 6, November-December, p. 761–768

Publication type: original article

Language: English

The Evaluation of Costs of Treating Abdominal Aortic Aneurysm

Ocena kosztów operacyjnego leczenia tętniaka aorty brzusznej

Jan J. Gnus1,, Wojciech Witkiewicz1,, Monika W. Pfanhauser1,, Willy Hauzer1,, Wojciech M. Piegza1,

1 General and Vascular Surgery Ward Regional Specialistic Hiospital in Wrocław, Research Centre Department of Dermatology, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Background. Since 1991, endovascular stentgraft implantation has been performed alongside traditional treatment of abdominal aortic aneurysm in patients with massive internal burden.
Objectives. Comparison of the costs of traditional treatment of abdominal aortic aneurysm with those of stentgraft implantation.
Material and Methods. In 2001–2006, 637 patients were treated at this surgical ward, of whom 521 had unruptured and 116 ruptured abdominal aortic aneurysm (RAAA). Of the 521 patients with unruptured abdominal aortic aneurysm, 418 were operated in the traditional way, 65 received an inner−vascular prosthesis implant, and 38 were disqualified from surgical treatment. Only the patients with massive internal burden were qualified for treatment: 31 with respiratory failure, 29 with circulatory failure grades IV/V according to the NYHA classification, 5 who had had a stroke with spastic hemiplegia.
Results. Using data from the financial department, the overall cost of treating the patients with an endovascular prosthesis was PLN 42,487.60, the cost of traditional treatment of patients with unruptured abdominal aortic aneurysm was PLN 10,074.16, and the cost of treating a ruptured abdominal aortic aneurysm was PLN 22,589.53.
Conclusion. The high costs of endovascular treatment are connected to the price of the prosthesis used, which constitutes 90% of the total cost. Among patients with an RAAA in serious overall condition, stentgraft implantation is a life−saving procedure. The total costs of treatment of a ruptured abdominal aortic aneurysm almost doubles the regular costs of treatment in planned mode. Early recognition and instant intervention with an unruptured abdominal aortic aneurysm significantly decrease the costs of treatment. Early conclusions about the treatment are presented here. Further analysis and observation are necessary to estimate subsequent results.

Streszczenie

Wprowadzenie. Od 1991 r. obok klasycznej metody operacyjnego leczenia tętniaka aorty brzusznej, szczególnie u chorych obciążonych internistycznie, wprowadzono endowaskularny sposób wszczepienia protezy samorozprężalnej.
Cel pracy. Porównanie kosztów operacyjnego leczenia tętniaka aorty brzusznej metodą klasyczną z kosztami wewnątrznaczyniowego wszczepienia protezy samorozprężalnej.
Materiał i metody. W latach 2001–2006 badaniem objęto 637 chorych z tętniakiem aorty brzusznej, spośród których 521 chorych przyjęto w trybie planowym z powodu tętniaka aorty brzusznej bez cech wynaczynienia, 116 chorych operowano w trybie ostrodyżurowym z powodu pękniętego tętniaka aorty. Spośród 521 chorych z tętniakiem aorty brzusznej, przyjętych planowo, sposobem klasycznym operowano 418 chorych, u 65 chorych wszczepiono protezę wewnątrznaczyniową, a 38 chorych nie zakwalifikowano do leczenia operacyjnego. Do zabiegu wszczepienia protezy wewnątrznaczyniowej zakwalifikowano 65 chorych znacznie obciążonych internistycznie, z których 31 miało niewydolność oddechową, 29 chorych niewydolność krążenia 4. i 5. st. w skali NYHA, a 5 chorych przebyło udar mózgu z porażeniem połowiczym.
Wyniki. Po uzyskaniu danych z działu marketingu obliczono całkowity koszt leczenia chorych z tętniakiem aorty brzusznej operowanych za pomocą endowaskularnego wszczepienia protezy wewnątrznaczyniowej, który wyniósł 42 435,60 PLN, koszt leczenia chorych leczonych w trybie planowym 10 074,16 PLN, a koszt chorych operowanych z powodu pękniętego tętniaka aorty brzusznej wyniósł 22 589,53 PLN.
Wnioski. Wysoki koszt leczenia endowaskularnego jest związany z ceną użytej protezy, która stanowi około 90% wszystkich kosztów. U chorych z TAB obciążonych internistycznie wszczepienie stentgraftu jest metodą ratującą życie. Całkowity koszt leczenia pękniętego tętniaka aorty brzusznej ponad dwukrotnie przewyższa koszt leczenia tętniaka aorty brzusznej operowanego w trybie planowym. Wczesne rozpoznanie i operacja niepękniętego tętniaka aorty brzusznej w znacznym stopniu przyczynia się do obniżenia kosztów leczenia. W pracy przedstawiono wczesne wyniki leczenia tętniaków aorty brzusznej, jest wskazana dalsza obserwacja w celu określenia wyników późnych.

Key words

abdominal aortic aneurysm, stentgraft, costs

Słowa kluczowe

tętniak aorty brzusznej, proteza wewnątrznaczyniowa, koszty leczenia

References (39)

  1. Ailawadi G, Eliason JL, Upchurch GR Jr: Current concepts in the pathogenesis of abdominal aortic aneurysm. J Vasc Surg 2003 38, 3, 584–588.
  2. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC: Suggested standards for reporting on arterial aneurysms: Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991, 13, 452–458.
  3. Kent KC, Zwolak RM, Jaff MR, Hollenbeck ST, Thompson RW, Schermernhorn ML, Sicard GA, Riles TS, Cronenwett JL: Screening for abdominal aortic aneurysm: a consensus statement. J Vasc Surg 2004, 39, 267–269.
  4. Ouriel K, Green RM, Donayre C, Shortell CK, Elliott J, De Weese JA: An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture. J Vasc Surg 1992, 15, 12–18.
  5. Van der Vliet JA, Boll APM: Abdominal aortic aneurysm. Lancet 1997 349, 863–866.
  6. Beebe HG: Imaging modalities for aortic endografting. J Endovasc Surg 1997, 4, 111–123.
  7. Huber TS, Wang JG, Derrow AE, Ozaki CK, Zelenock GB, Flynn TC, Seeger JM: Experience in the United States with intact abdominal aortic aneurysm repair. J Vasc Surg 2001, 33, 304–310.
  8. MacSweeney ST, Powell JT, Greenhalgh RML: Pathogenesis of abdominal aortic aneurysm. Br J Surg 1994, 81, 935–941.
  9. Cronenwett JL, Johnston KW: The United Kingdom Small Aneurysm Trial: implications for surgical treatment of abdominal aortic aneurysms. J Vasc Surg 1999, 29, 191–194.
  10. Diehm N, Herrmann P, Dinkel HP: Multidetector CT angiography versus digital subtraction angiography for aortoiliac length measurements prior to endovascular AAA repair. J Endovasc Ther 2004, 11, 527–534.
  11. Zarins CK, Xu C, Glagov S: Atherosclerotic enlargement of the human abdominal aorta. Atherosclerosis 2001, 155, 157–164.
  12. Grange JJ, Davis V, Baxer BT: Pathogenesis of abdominal aortic aneurysm: an update and look toward the future. Cardiovasc Surg 1997, 5, 256–265.
  13. Broeders IA, Blankensteijn JD, Olree M, Mali W, Eikelboom BC: Preoperative sizing of grafts for transfemoral endovascular aneurysms management: a prospective comparative study of spiral CT angiography, arteriography and conventional CT imaging. J Endovasc Surg 1997, 4, 252–261.
  14. Banach A: Stentgraft w aorcie. Primum non nocere. Biuletyn Bydgoskiej Izby Lekarskiej 2004, 5(155), 12.
  15. Lederle FA: Endovascular Repair of Abdominal Aortic Aneurysm – Round Two. 2005 NEJM 352, 2443–2445.
  16. Bengtsson H, Bergqvist D, Sternby NH: Increasing prevalence of abdominal aorticaneurysms: a necropsy study. Eur J Surg 1992, 158, 19–23.
  17. Becqemin, JP, Lampie V, Favre JP: Mid−term results of a second generation biforucated endovascular graft for abdominal aortic aneurysm repair: the French Vanguard trial. J Vasc Surg 1999, 30, 209–218.
  18. Blankensteijn JD, de Jong SECA, Prinssen M, van der Ham AC, Buth J, van Strekenburg S, Verhagen H, Buskens E, Grobbee DE: The Dutch Randomized Endovascular Aneurysm Management (2005). Two−Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms. NEJM 2005, 352, 2398–2405.
  19. Chong CK, How TV: Flow patterns in an endovascular stent−graft for abdominal aortic aneurysm repair: J Biomech 2004, 37, 89–97.
  20. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG: Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30−day operative mortality results: randomised controlled trial. Lancet 2004, 364, 843–848.
  21. White GH, May J, Waugh RC, Chaufour X, Yu W: Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surg 1998, 5, 305–309.
  22. Cuypers Ph, Nevelsteen A, Buth J, Hamming J, Stockx L, Lacroix H, Tielbeek A: Complications in the Endovascular Rapair of Abdominal Aortic Aneurysms: a Risk Factor Analysis. Eur J Vasc Endovasc Surg 1999, 18, 245–252, 245–252.
  23. Fillinger MF: Postoperative imaging after endovascular AAA repair. Semin Vasc Surg 1999, 12, 327–338.
  24. Resch T, Malina M, Lindblad B, Malina J, Brukwall J, Ivancev K: The impact of stent design on proximal stent−graft fixation in the abdominal aorta: an experimental study. Eur J Vasc Endovasc Surg 2000, 20, 190–195.
  25. Nowicki M, Andziak P, Mazurkiewicz A, Sybilski M, Furmanek M: Śródnaczyniowa implantacja stentgraftów aortalnych – 5 lat doświadczeń. Pol J Radiol, 2006, 71(1), 32–38.
  26. Maruszyński M, Osiecki M, Staroń K: Leczenie chorych z tętniakiem aorty brzusznej przy użyciu rozwidlonych stent−graftów aortalnych. Pol Merk Lek 2005, 18 (105), 253–256.
  27. Rutherford RB: Endovascular Aneurysm Repair Versus Open Repair in Patients With Abdominal Aortic Aneurysm (EVAR Trial): Randomized Controlled Trial. Perspect Vasc Surg Endovasc Ther 2006, 18, 74–76.
  28. Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewjik C, Laheij RJ: Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg 2000, 32, 739–749.
  29. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek M, Balm R, Buskens E, Grobbee D, Blankenstijn JD: A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004, 351, 1607–1618.
  30. Wain RA, Marin ML, Ohki T, Sanchez LA, Lyon RT, Rozenblit A, Suggs WD, Yuan JG, Veith FJ: Endoleaks after endovascular graft treatment of aortic aneurysms: classification, risk factors and outcome. J Vasc Surg 1998, 27, 69–78.
  31. White GH, Yu W, May J: Endoleak: a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg 1996, 3, 124–125.
  32. Zarins CK, White RA, Hodgson KJ, Schwarten D, Fogarty TJ: Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg 2000, 32, 90–107.
  33. Eliasom J, Wainess R, Dimick J, Cowan J, Henke P, Stanley J, Upchurch G: The effect of secondary operations on mortality following abdominal aortic aneurysm repair in the United States: 1988–2001. Vasc Endovasc Surg 2005, 39 (6), 465–472.
  34. Ouriel K, Geary K, Green R: Factors determining survival after ruptured aortic aneurysm: the hospital, the surgeon, and the patient. J Vasc Surg 1990, 11, 493–496.
  35. Zarins CK, Wolf YG, Lee WA, Hill BB, Olcott C, Harris J, Dalman RL, Fogarty TJ: Will endovascular repair replace open surgery for abdominal aortic aneurysm repair? Ann Surg 2000, 232(4), 501–507.
  36. Gnus J, Witkiewicz W, HauzerW: Ocena kosztów operacji pękniętego i niepękniętego tętniaka aorty brzusznej. Pol Merk Lek 2006, XX, 117, 279–291.
  37. Meenan RT, Fleming C, Whitlock EP, Beil T, Smith P: Cost−effectiveness analyses of population−based screening for abdominal aortic aneurysm: evidence synthesis. Rockville, MD: Agency for Healthcare Research and Quality, January 2004.
  38. Patel ST, Haser PB, Bush HL Jr: The cost−effectivness of endovascular repair versus open surgical repair of abdominal aortic aneurmysms: A decision analysis model. J Vasc Surg 1999, 29, 6, 958–972.
  39. Tang T, Lindop M, Munday I: A cost analysis of surgery for ruptured abdominal aortic aneurysm. Eur J Endovasc Surg 1997, 26, 299–302.
© Wroclaw Medical University