Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial

Frank A. Lederle, Kevin T. Stroupe, Tassos C. Kyriakides, Ling Ge, Julie A. Freischlag, Erika R. Ketteler, Darra D. Kingsley, John M. Marek, Richard J. Massen, Brian D. Matteson, J. David Pitcher, Mark Langsfeld, John D. Corson, James M. Goff, Karthnik Kasirajan, Christina Paap, Diane C. Robertson, Atef Salam, Ravi Veeraswamy, Ross MilnerKarthikeshwar Kasirajan, Jane Guidot, Brajesh K. Lal, Steven J. Busuttil, Michael P. Lilly, Melita Braganza, Kea Ellis, Mark A. Patterson, William D. Jordan, David Whitley, Steve Taylor, Marc Passman, Donna Kerns, Cindy Inman, Jennifer Poirier, James Ebaugh, Joseph Raffetto, David Chew, Subhash Lathi, Christopher Owens, Kathleen Hickson, Hasan H. Dosluoglu, Karen Eschberger, Melina R. Kibbe, Henry M. Baraniewski, Jon Matsumura, Michelle Endo, Anna Busman, Wendy Meadows, Mary Evans, Joseph S. Giglia, Hosam El Sayed, Amy B. Reed, Madeline Ruf, Stephanie Ross, Jessie M. Jean-Claude, Gilles Pinault, Preet Kang, Nadine White, Matthew Eiseman, Reba Jones, Carlos H. Timaran, J. Gregory Modrall, M. Burress Welborn, Jorge Lopez, Tammy Nguyen, John K Y Chacko, Kenneth Granke, Angela G. Vouyouka, Erin Olgren, Prakash Chand, Brenda Allende, Michael Ranella, Claudia Yales, Thomas A. Whitehill, William C. Krupski, Mark R. Nehler, Stephen P. Johnson, Darrell N. Jones, Pamela Strecker, Michelle A. Bhola, Cynthia K. Shortell, John L. Gray, Jeffrey H. Lawson, Richard McCann, Mark W. Sebastian, Jean Kistler Tetterton, Carla Blackwell, Patricia A. Prinzo, Nina Lee, Frank T. Padberg, Joaquim J. Cerveira, Robert W. Zickler, Karen A. Hauck, Scott A. Berceli, W. Anthony Lee, C. Keith Ozaki, Peter R. Nelson, Anne S. Irwin, Randy Baum, Bernadette Aulivola, Heron Rodriguez, Fred N. Littooy, Howard Greisler, Mary T. O'Sullivan, Panagiotis Kougias, Peter H. Lin, Ruth L. Bush, Gene Guinn, Carlos Bechara, Catherine Cagiannos, George Pisimisis, Neal Barshes, Sherilyn Pillack, Barbara Guillory, Dolores Cikrit, Stephen G. Lalka, Gary Lemmon, Ryan Nachreiner, Mitzi Rusomaroff, Elaine O'Brien, Joseph J. Cullen, Jamal Hoballah, W. John Sharp, Jeanne L. McCandless, Vickie Beach, David Minion, Thomas H. Schwarcz, Joy Kimbrough, Laura Ashe, Anna Rockich, Jill Warner-Carpenter, Mohammed Moursi, John F. Eidt, Sandra Brock, Christian Bianchi, Vicki Bishop, Ian L. Gordon, Roy Fujitani, Stephen M. Kubaska, Mina Behdad, Reza Azadegan, Christine Maagas, Kathy Zalecki, John R. Hoch, Sandra C. Carr, Charles Acher, Margaret Schwarze, Girma Tefera, Matthew Mell, Beth Dunlap, Janice Rieder, John M. Stuart, Darryl S. Weiman, Omran Abul-Khoudoud, H. Edward Garrett, Sandra M. Walsh, Karen L. Wilson, Gary R. Seabrook, Robert A. Cambria, Kellie R. Brown, Brian D. Lewis, Susan Framberg, Christa Kallio, Roderick A. Barke, Steven M. Santilli, Alexandre C. D'Audiffret, Nancy Oberle, Catherine Proebstle, Lauri Lee Johnson, Glenn R. Jacobowitz, Neal Cayne, Caron Rockman, Mark Adelman, Paul Gagne, Matthew Nalbandian, Leah J. Caropolo, Iraklis I. Pipinos, Jason Johanning, Thomas Lynch, Holly De Spiegelaere, Georgia Purviance, Wei Zhou, Ronald Dalman, Jason T. Lee, Bassem Safadi, Sheila M. Coogan, Sherry M. Wren, Doghdoo D. Bahmani, Deanna Maples, Shawna Thunen, Michael A. Golden, Marc E. Mitchell, Ronald Fairman, Sally Reinhardt, Mark A. Wilson, Edith Tzeng, Satish Muluk, Nina M. Peterson, Maria Foster, James Edwards, Gregory (Greg) Moneta, Gregory Landry, Lloyd Taylor, Richard Yeager, Eleanor Cannady, Gerald Treiman, Stephanie Hatton-Ward, Barbara Salabsky, Nikhil Kansal, Erik Owens, Melanie Estes, Beth A. Forbes, Cinda Sobotta, Joseph H. Rapp, Linda M. Reilly, Sandra L. Perez, Kimberly Yan, Rajaabrata Sarkar, Shelley S. Dwyer, Karen Chong, Ted R. Kohler, Thomas S. Hatsukami, David G. Glickerman, Michael Sobel, Thomas S. Burdick, Kimberly Pedersen, Patricia Cleary, Martin Back, Dennis Bandyk, Brad Johnson, Murray Shames, Rebecca L. Reinhard, Sandra C. Thomas, Glenn C. Hunter, Luis R. Leon, Alex Westerband, Robert J. Guerra, Macario Riveros, John L. Mills, John D. Hughes, Andrea M. Escalante, Shemuel B. Psalms, Nancy N. Day, Robyn Macsata, Anton Sidawy, Jonathan Weiswasser, Subodh Arora, Brenda J. Jasper, Alan Dardik, Vivian Gahtan, Bart E. Muhs, Bauer E. Sumpio, Richard J. Gusberg, Marcelo Spector, Jeffrey Pollak, John Aruny, E. Lynne Kelly, James Wong, Penny Vasilas, Carmelene Joncas, Hugh A. Gelabert, Christian De Virgillio, David A. Rigberg, Loretta Cole, Elizabeth Latts, Kathleen M. Swanson, Gary R. Johnson, Peter Guarino, Peter Peduzzi, Margaret Antonelli, Cindy Cushing, Elizabeth Davis, Lynn Durant, Shirley Joyner, Alice Kossack, Mary Le Gwin, Vanessa McBride, Terry O'Connor, June Poulton, Susan Stratton, Scott Zellner, Amanda J. Snodgrass, Julie Thornton, Clair M. Haakenson, Yvonne Jonk, John W. Hallett, Norman Hertzer, Jonathan Towne, David A. Katz, Theodore Karrison, John P. Matts, Richard Marottoli, Stanislav Kasl, Rajni Mehta, Richard Feldman, William Farrell, Heather Allore, Edward Perry, James Niederman, Sister Frances Randall, Reverend Michael Zeman, Donald Beckwith, Timothy J. O'Leary, Grant D. Huang, Marilyn Bader

    Research output: Contribution to journalArticle

    12 Citations (Scopus)

    Abstract

    IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

    Original languageEnglish (US)
    Pages (from-to)1139-1144
    Number of pages6
    JournalJAMA Surgery
    Volume151
    Issue number12
    DOIs
    StatePublished - Dec 1 2016

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    Abdominal Aortic Aneurysm
    Veterans
    Cost-Benefit Analysis
    Randomized Controlled Trials
    Costs and Cost Analysis
    Quality-Adjusted Life Years
    Health Care Costs
    Endovascular Procedures
    Health Services
    Hospitalization
    Quality of Life
    Survival

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Lederle, F. A., Stroupe, K. T., Kyriakides, T. C., Ge, L., Freischlag, J. A., Ketteler, E. R., ... Bader, M. (2016). Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial. JAMA Surgery, 151(12), 1139-1144. https://doi.org/10.1001/jamasurg.2016.2783

    Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm : A randomized clinical trial. / Lederle, Frank A.; Stroupe, Kevin T.; Kyriakides, Tassos C.; Ge, Ling; Freischlag, Julie A.; Ketteler, Erika R.; Kingsley, Darra D.; Marek, John M.; Massen, Richard J.; Matteson, Brian D.; David Pitcher, J.; Langsfeld, Mark; Corson, John D.; Goff, James M.; Kasirajan, Karthnik; Paap, Christina; Robertson, Diane C.; Salam, Atef; Veeraswamy, Ravi; Milner, Ross; Kasirajan, Karthikeshwar; Guidot, Jane; Lal, Brajesh K.; Busuttil, Steven J.; Lilly, Michael P.; Braganza, Melita; Ellis, Kea; Patterson, Mark A.; Jordan, William D.; Whitley, David; Taylor, Steve; Passman, Marc; Kerns, Donna; Inman, Cindy; Poirier, Jennifer; Ebaugh, James; Raffetto, Joseph; Chew, David; Lathi, Subhash; Owens, Christopher; Hickson, Kathleen; Dosluoglu, Hasan H.; Eschberger, Karen; Kibbe, Melina R.; Baraniewski, Henry M.; Matsumura, Jon; Endo, Michelle; Busman, Anna; Meadows, Wendy; Evans, Mary; Giglia, Joseph S.; El Sayed, Hosam; Reed, Amy B.; Ruf, Madeline; Ross, Stephanie; Jean-Claude, Jessie M.; Pinault, Gilles; Kang, Preet; White, Nadine; Eiseman, Matthew; Jones, Reba; Timaran, Carlos H.; Gregory Modrall, J.; Burress Welborn, M.; Lopez, Jorge; Nguyen, Tammy; Chacko, John K Y; Granke, Kenneth; Vouyouka, Angela G.; Olgren, Erin; Chand, Prakash; Allende, Brenda; Ranella, Michael; Yales, Claudia; Whitehill, Thomas A.; Krupski, William C.; Nehler, Mark R.; Johnson, Stephen P.; Jones, Darrell N.; Strecker, Pamela; Bhola, Michelle A.; Shortell, Cynthia K.; Gray, John L.; Lawson, Jeffrey H.; McCann, Richard; Sebastian, Mark W.; Tetterton, Jean Kistler; Blackwell, Carla; Prinzo, Patricia A.; Lee, Nina; Padberg, Frank T.; Cerveira, Joaquim J.; Zickler, Robert W.; Hauck, Karen A.; Berceli, Scott A.; Anthony Lee, W.; Keith Ozaki, C.; Nelson, Peter R.; Irwin, Anne S.; Baum, Randy; Aulivola, Bernadette; Rodriguez, Heron; Littooy, Fred N.; Greisler, Howard; O'Sullivan, Mary T.; Kougias, Panagiotis; Lin, Peter H.; Bush, Ruth L.; Guinn, Gene; Bechara, Carlos; Cagiannos, Catherine; Pisimisis, George; Barshes, Neal; Pillack, Sherilyn; Guillory, Barbara; Cikrit, Dolores; Lalka, Stephen G.; Lemmon, Gary; Nachreiner, Ryan; Rusomaroff, Mitzi; O'Brien, Elaine; Cullen, Joseph J.; Hoballah, Jamal; John Sharp, W.; McCandless, Jeanne L.; Beach, Vickie; Minion, David; Schwarcz, Thomas H.; Kimbrough, Joy; Ashe, Laura; Rockich, Anna; Warner-Carpenter, Jill; Moursi, Mohammed; Eidt, John F.; Brock, Sandra; Bianchi, Christian; Bishop, Vicki; Gordon, Ian L.; Fujitani, Roy; Kubaska, Stephen M.; Behdad, Mina; Azadegan, Reza; Maagas, Christine; Zalecki, Kathy; Hoch, John R.; Carr, Sandra C.; Acher, Charles; Schwarze, Margaret; Tefera, Girma; Mell, Matthew; Dunlap, Beth; Rieder, Janice; Stuart, John M.; Weiman, Darryl S.; Abul-Khoudoud, Omran; Edward Garrett, H.; Walsh, Sandra M.; Wilson, Karen L.; Seabrook, Gary R.; Cambria, Robert A.; Brown, Kellie R.; Lewis, Brian D.; Framberg, Susan; Kallio, Christa; Barke, Roderick A.; Santilli, Steven M.; D'Audiffret, Alexandre C.; Oberle, Nancy; Proebstle, Catherine; Johnson, Lauri Lee; Jacobowitz, Glenn R.; Cayne, Neal; Rockman, Caron; Adelman, Mark; Gagne, Paul; Nalbandian, Matthew; Caropolo, Leah J.; Pipinos, Iraklis I.; Johanning, Jason; Lynch, Thomas; De Spiegelaere, Holly; Purviance, Georgia; Zhou, Wei; Dalman, Ronald; Lee, Jason T.; Safadi, Bassem; Coogan, Sheila M.; Wren, Sherry M.; Bahmani, Doghdoo D.; Maples, Deanna; Thunen, Shawna; Golden, Michael A.; Mitchell, Marc E.; Fairman, Ronald; Reinhardt, Sally; Wilson, Mark A.; Tzeng, Edith; Muluk, Satish; Peterson, Nina M.; Foster, Maria; Edwards, James; Moneta, Gregory (Greg); Landry, Gregory; Taylor, Lloyd; Yeager, Richard; Cannady, Eleanor; Treiman, Gerald; Hatton-Ward, Stephanie; Salabsky, Barbara; Kansal, Nikhil; Owens, Erik; Estes, Melanie; Forbes, Beth A.; Sobotta, Cinda; Rapp, Joseph H.; Reilly, Linda M.; Perez, Sandra L.; Yan, Kimberly; Sarkar, Rajaabrata; Dwyer, Shelley S.; Chong, Karen; Kohler, Ted R.; Hatsukami, Thomas S.; Glickerman, David G.; Sobel, Michael; Burdick, Thomas S.; Pedersen, Kimberly; Cleary, Patricia; Back, Martin; Bandyk, Dennis; Johnson, Brad; Shames, Murray; Reinhard, Rebecca L.; Thomas, Sandra C.; Hunter, Glenn C.; Leon, Luis R.; Westerband, Alex; Guerra, Robert J.; Riveros, Macario; Mills, John L.; Hughes, John D.; Escalante, Andrea M.; Psalms, Shemuel B.; Day, Nancy N.; Macsata, Robyn; Sidawy, Anton; Weiswasser, Jonathan; Arora, Subodh; Jasper, Brenda J.; Dardik, Alan; Gahtan, Vivian; Muhs, Bart E.; Sumpio, Bauer E.; Gusberg, Richard J.; Spector, Marcelo; Pollak, Jeffrey; Aruny, John; Lynne Kelly, E.; Wong, James; Vasilas, Penny; Joncas, Carmelene; Gelabert, Hugh A.; De Virgillio, Christian; Rigberg, David A.; Cole, Loretta; Latts, Elizabeth; Swanson, Kathleen M.; Johnson, Gary R.; Guarino, Peter; Peduzzi, Peter; Antonelli, Margaret; Cushing, Cindy; Davis, Elizabeth; Durant, Lynn; Joyner, Shirley; Kossack, Alice; Le Gwin, Mary; McBride, Vanessa; O'Connor, Terry; Poulton, June; Stratton, Susan; Zellner, Scott; Snodgrass, Amanda J.; Thornton, Julie; Haakenson, Clair M.; Jonk, Yvonne; Hallett, John W.; Hertzer, Norman; Towne, Jonathan; Katz, David A.; Karrison, Theodore; Matts, John P.; Marottoli, Richard; Kasl, Stanislav; Mehta, Rajni; Feldman, Richard; Farrell, William; Allore, Heather; Perry, Edward; Niederman, James; Randall, Sister Frances; Zeman, Reverend Michael; Beckwith, Donald; O'Leary, Timothy J.; Huang, Grant D.; Bader, Marilyn.

    In: JAMA Surgery, Vol. 151, No. 12, 01.12.2016, p. 1139-1144.

    Research output: Contribution to journalArticle

    Lederle, FA, Stroupe, KT, Kyriakides, TC, Ge, L, Freischlag, JA, Ketteler, ER, Kingsley, DD, Marek, JM, Massen, RJ, Matteson, BD, David Pitcher, J, Langsfeld, M, Corson, JD, Goff, JM, Kasirajan, K, Paap, C, Robertson, DC, Salam, A, Veeraswamy, R, Milner, R, Kasirajan, K, Guidot, J, Lal, BK, Busuttil, SJ, Lilly, MP, Braganza, M, Ellis, K, Patterson, MA, Jordan, WD, Whitley, D, Taylor, S, Passman, M, Kerns, D, Inman, C, Poirier, J, Ebaugh, J, Raffetto, J, Chew, D, Lathi, S, Owens, C, Hickson, K, Dosluoglu, HH, Eschberger, K, Kibbe, MR, Baraniewski, HM, Matsumura, J, Endo, M, Busman, A, Meadows, W, Evans, M, Giglia, JS, El Sayed, H, Reed, AB, Ruf, M, Ross, S, Jean-Claude, JM, Pinault, G, Kang, P, White, N, Eiseman, M, Jones, R, Timaran, CH, Gregory Modrall, J, Burress Welborn, M, Lopez, J, Nguyen, T, Chacko, JKY, Granke, K, Vouyouka, AG, Olgren, E, Chand, P, Allende, B, Ranella, M, Yales, C, Whitehill, TA, Krupski, WC, Nehler, MR, Johnson, SP, Jones, DN, Strecker, P, Bhola, MA, Shortell, CK, Gray, JL, Lawson, JH, McCann, R, Sebastian, MW, Tetterton, JK, Blackwell, C, Prinzo, PA, Lee, N, Padberg, FT, Cerveira, JJ, Zickler, RW, Hauck, KA, Berceli, SA, Anthony Lee, W, Keith Ozaki, C, Nelson, PR, Irwin, AS, Baum, R, Aulivola, B, Rodriguez, H, Littooy, FN, Greisler, H, O'Sullivan, MT, Kougias, P, Lin, PH, Bush, RL, Guinn, G, Bechara, C, Cagiannos, C, Pisimisis, G, Barshes, N, Pillack, S, Guillory, B, Cikrit, D, Lalka, SG, Lemmon, G, Nachreiner, R, Rusomaroff, M, O'Brien, E, Cullen, JJ, Hoballah, J, John Sharp, W, McCandless, JL, Beach, V, Minion, D, Schwarcz, TH, Kimbrough, J, Ashe, L, Rockich, A, Warner-Carpenter, J, Moursi, M, Eidt, JF, Brock, S, Bianchi, C, Bishop, V, Gordon, IL, Fujitani, R, Kubaska, SM, Behdad, M, Azadegan, R, Maagas, C, Zalecki, K, Hoch, JR, Carr, SC, Acher, C, Schwarze, M, Tefera, G, Mell, M, Dunlap, B, Rieder, J, Stuart, JM, Weiman, DS, Abul-Khoudoud, O, Edward Garrett, H, Walsh, SM, Wilson, KL, Seabrook, GR, Cambria, RA, Brown, KR, Lewis, BD, Framberg, S, Kallio, C, Barke, RA, Santilli, SM, D'Audiffret, AC, Oberle, N, Proebstle, C, Johnson, LL, Jacobowitz, GR, Cayne, N, Rockman, C, Adelman, M, Gagne, P, Nalbandian, M, Caropolo, LJ, Pipinos, II, Johanning, J, Lynch, T, De Spiegelaere, H, Purviance, G, Zhou, W, Dalman, R, Lee, JT, Safadi, B, Coogan, SM, Wren, SM, Bahmani, DD, Maples, D, Thunen, S, Golden, MA, Mitchell, ME, Fairman, R, Reinhardt, S, Wilson, MA, Tzeng, E, Muluk, S, Peterson, NM, Foster, M, Edwards, J, Moneta, GG, Landry, G, Taylor, L, Yeager, R, Cannady, E, Treiman, G, Hatton-Ward, S, Salabsky, B, Kansal, N, Owens, E, Estes, M, Forbes, BA, Sobotta, C, Rapp, JH, Reilly, LM, Perez, SL, Yan, K, Sarkar, R, Dwyer, SS, Chong, K, Kohler, TR, Hatsukami, TS, Glickerman, DG, Sobel, M, Burdick, TS, Pedersen, K, Cleary, P, Back, M, Bandyk, D, Johnson, B, Shames, M, Reinhard, RL, Thomas, SC, Hunter, GC, Leon, LR, Westerband, A, Guerra, RJ, Riveros, M, Mills, JL, Hughes, JD, Escalante, AM, Psalms, SB, Day, NN, Macsata, R, Sidawy, A, Weiswasser, J, Arora, S, Jasper, BJ, Dardik, A, Gahtan, V, Muhs, BE, Sumpio, BE, Gusberg, RJ, Spector, M, Pollak, J, Aruny, J, Lynne Kelly, E, Wong, J, Vasilas, P, Joncas, C, Gelabert, HA, De Virgillio, C, Rigberg, DA, Cole, L, Latts, E, Swanson, KM, Johnson, GR, Guarino, P, Peduzzi, P, Antonelli, M, Cushing, C, Davis, E, Durant, L, Joyner, S, Kossack, A, Le Gwin, M, McBride, V, O'Connor, T, Poulton, J, Stratton, S, Zellner, S, Snodgrass, AJ, Thornton, J, Haakenson, CM, Jonk, Y, Hallett, JW, Hertzer, N, Towne, J, Katz, DA, Karrison, T, Matts, JP, Marottoli, R, Kasl, S, Mehta, R, Feldman, R, Farrell, W, Allore, H, Perry, E, Niederman, J, Randall, SF, Zeman, RM, Beckwith, D, O'Leary, TJ, Huang, GD & Bader, M 2016, 'Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial', JAMA Surgery, vol. 151, no. 12, pp. 1139-1144. https://doi.org/10.1001/jamasurg.2016.2783
    Lederle, Frank A. ; Stroupe, Kevin T. ; Kyriakides, Tassos C. ; Ge, Ling ; Freischlag, Julie A. ; Ketteler, Erika R. ; Kingsley, Darra D. ; Marek, John M. ; Massen, Richard J. ; Matteson, Brian D. ; David Pitcher, J. ; Langsfeld, Mark ; Corson, John D. ; Goff, James M. ; Kasirajan, Karthnik ; Paap, Christina ; Robertson, Diane C. ; Salam, Atef ; Veeraswamy, Ravi ; Milner, Ross ; Kasirajan, Karthikeshwar ; Guidot, Jane ; Lal, Brajesh K. ; Busuttil, Steven J. ; Lilly, Michael P. ; Braganza, Melita ; Ellis, Kea ; Patterson, Mark A. ; Jordan, William D. ; Whitley, David ; Taylor, Steve ; Passman, Marc ; Kerns, Donna ; Inman, Cindy ; Poirier, Jennifer ; Ebaugh, James ; Raffetto, Joseph ; Chew, David ; Lathi, Subhash ; Owens, Christopher ; Hickson, Kathleen ; Dosluoglu, Hasan H. ; Eschberger, Karen ; Kibbe, Melina R. ; Baraniewski, Henry M. ; Matsumura, Jon ; Endo, Michelle ; Busman, Anna ; Meadows, Wendy ; Evans, Mary ; Giglia, Joseph S. ; El Sayed, Hosam ; Reed, Amy B. ; Ruf, Madeline ; Ross, Stephanie ; Jean-Claude, Jessie M. ; Pinault, Gilles ; Kang, Preet ; White, Nadine ; Eiseman, Matthew ; Jones, Reba ; Timaran, Carlos H. ; Gregory Modrall, J. ; Burress Welborn, M. ; Lopez, Jorge ; Nguyen, Tammy ; Chacko, John K Y ; Granke, Kenneth ; Vouyouka, Angela G. ; Olgren, Erin ; Chand, Prakash ; Allende, Brenda ; Ranella, Michael ; Yales, Claudia ; Whitehill, Thomas A. ; Krupski, William C. ; Nehler, Mark R. ; Johnson, Stephen P. ; Jones, Darrell N. ; Strecker, Pamela ; Bhola, Michelle A. ; Shortell, Cynthia K. ; Gray, John L. ; Lawson, Jeffrey H. ; McCann, Richard ; Sebastian, Mark W. ; Tetterton, Jean Kistler ; Blackwell, Carla ; Prinzo, Patricia A. ; Lee, Nina ; Padberg, Frank T. ; Cerveira, Joaquim J. ; Zickler, Robert W. ; Hauck, Karen A. ; Berceli, Scott A. ; Anthony Lee, W. ; Keith Ozaki, C. ; Nelson, Peter R. ; Irwin, Anne S. ; Baum, Randy ; Aulivola, Bernadette ; Rodriguez, Heron ; Littooy, Fred N. ; Greisler, Howard ; O'Sullivan, Mary T. ; Kougias, Panagiotis ; Lin, Peter H. ; Bush, Ruth L. ; Guinn, Gene ; Bechara, Carlos ; Cagiannos, Catherine ; Pisimisis, George ; Barshes, Neal ; Pillack, Sherilyn ; Guillory, Barbara ; Cikrit, Dolores ; Lalka, Stephen G. ; Lemmon, Gary ; Nachreiner, Ryan ; Rusomaroff, Mitzi ; O'Brien, Elaine ; Cullen, Joseph J. ; Hoballah, Jamal ; John Sharp, W. ; McCandless, Jeanne L. ; Beach, Vickie ; Minion, David ; Schwarcz, Thomas H. ; Kimbrough, Joy ; Ashe, Laura ; Rockich, Anna ; Warner-Carpenter, Jill ; Moursi, Mohammed ; Eidt, John F. ; Brock, Sandra ; Bianchi, Christian ; Bishop, Vicki ; Gordon, Ian L. ; Fujitani, Roy ; Kubaska, Stephen M. ; Behdad, Mina ; Azadegan, Reza ; Maagas, Christine ; Zalecki, Kathy ; Hoch, John R. ; Carr, Sandra C. ; Acher, Charles ; Schwarze, Margaret ; Tefera, Girma ; Mell, Matthew ; Dunlap, Beth ; Rieder, Janice ; Stuart, John M. ; Weiman, Darryl S. ; Abul-Khoudoud, Omran ; Edward Garrett, H. ; Walsh, Sandra M. ; Wilson, Karen L. ; Seabrook, Gary R. ; Cambria, Robert A. ; Brown, Kellie R. ; Lewis, Brian D. ; Framberg, Susan ; Kallio, Christa ; Barke, Roderick A. ; Santilli, Steven M. ; D'Audiffret, Alexandre C. ; Oberle, Nancy ; Proebstle, Catherine ; Johnson, Lauri Lee ; Jacobowitz, Glenn R. ; Cayne, Neal ; Rockman, Caron ; Adelman, Mark ; Gagne, Paul ; Nalbandian, Matthew ; Caropolo, Leah J. ; Pipinos, Iraklis I. ; Johanning, Jason ; Lynch, Thomas ; De Spiegelaere, Holly ; Purviance, Georgia ; Zhou, Wei ; Dalman, Ronald ; Lee, Jason T. ; Safadi, Bassem ; Coogan, Sheila M. ; Wren, Sherry M. ; Bahmani, Doghdoo D. ; Maples, Deanna ; Thunen, Shawna ; Golden, Michael A. ; Mitchell, Marc E. ; Fairman, Ronald ; Reinhardt, Sally ; Wilson, Mark A. ; Tzeng, Edith ; Muluk, Satish ; Peterson, Nina M. ; Foster, Maria ; Edwards, James ; Moneta, Gregory (Greg) ; Landry, Gregory ; Taylor, Lloyd ; Yeager, Richard ; Cannady, Eleanor ; Treiman, Gerald ; Hatton-Ward, Stephanie ; Salabsky, Barbara ; Kansal, Nikhil ; Owens, Erik ; Estes, Melanie ; Forbes, Beth A. ; Sobotta, Cinda ; Rapp, Joseph H. ; Reilly, Linda M. ; Perez, Sandra L. ; Yan, Kimberly ; Sarkar, Rajaabrata ; Dwyer, Shelley S. ; Chong, Karen ; Kohler, Ted R. ; Hatsukami, Thomas S. ; Glickerman, David G. ; Sobel, Michael ; Burdick, Thomas S. ; Pedersen, Kimberly ; Cleary, Patricia ; Back, Martin ; Bandyk, Dennis ; Johnson, Brad ; Shames, Murray ; Reinhard, Rebecca L. ; Thomas, Sandra C. ; Hunter, Glenn C. ; Leon, Luis R. ; Westerband, Alex ; Guerra, Robert J. ; Riveros, Macario ; Mills, John L. ; Hughes, John D. ; Escalante, Andrea M. ; Psalms, Shemuel B. ; Day, Nancy N. ; Macsata, Robyn ; Sidawy, Anton ; Weiswasser, Jonathan ; Arora, Subodh ; Jasper, Brenda J. ; Dardik, Alan ; Gahtan, Vivian ; Muhs, Bart E. ; Sumpio, Bauer E. ; Gusberg, Richard J. ; Spector, Marcelo ; Pollak, Jeffrey ; Aruny, John ; Lynne Kelly, E. ; Wong, James ; Vasilas, Penny ; Joncas, Carmelene ; Gelabert, Hugh A. ; De Virgillio, Christian ; Rigberg, David A. ; Cole, Loretta ; Latts, Elizabeth ; Swanson, Kathleen M. ; Johnson, Gary R. ; Guarino, Peter ; Peduzzi, Peter ; Antonelli, Margaret ; Cushing, Cindy ; Davis, Elizabeth ; Durant, Lynn ; Joyner, Shirley ; Kossack, Alice ; Le Gwin, Mary ; McBride, Vanessa ; O'Connor, Terry ; Poulton, June ; Stratton, Susan ; Zellner, Scott ; Snodgrass, Amanda J. ; Thornton, Julie ; Haakenson, Clair M. ; Jonk, Yvonne ; Hallett, John W. ; Hertzer, Norman ; Towne, Jonathan ; Katz, David A. ; Karrison, Theodore ; Matts, John P. ; Marottoli, Richard ; Kasl, Stanislav ; Mehta, Rajni ; Feldman, Richard ; Farrell, William ; Allore, Heather ; Perry, Edward ; Niederman, James ; Randall, Sister Frances ; Zeman, Reverend Michael ; Beckwith, Donald ; O'Leary, Timothy J. ; Huang, Grant D. ; Bader, Marilyn. / Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm : A randomized clinical trial. In: JAMA Surgery. 2016 ; Vol. 151, No. 12. pp. 1139-1144.
    @article{44cb9038b0e5416a81aea9a818c1422c,
    title = "Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial",
    abstract = "IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4{\%}]; 5 women [0.6{\%}]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95{\%} CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40{\%} of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95{\%} CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8{\%} when effectiveness was measured in life-years and 55.4{\%} when effectiveness was measured in QALYs for total costs and 31.3{\%} and 34.3{\%}, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.",
    author = "Lederle, {Frank A.} and Stroupe, {Kevin T.} and Kyriakides, {Tassos C.} and Ling Ge and Freischlag, {Julie A.} and Ketteler, {Erika R.} and Kingsley, {Darra D.} and Marek, {John M.} and Massen, {Richard J.} and Matteson, {Brian D.} and {David Pitcher}, J. and Mark Langsfeld and Corson, {John D.} and Goff, {James M.} and Karthnik Kasirajan and Christina Paap and Robertson, {Diane C.} and Atef Salam and Ravi Veeraswamy and Ross Milner and Karthikeshwar Kasirajan and Jane Guidot and Lal, {Brajesh K.} and Busuttil, {Steven J.} and Lilly, {Michael P.} and Melita Braganza and Kea Ellis and Patterson, {Mark A.} and Jordan, {William D.} and David Whitley and Steve Taylor and Marc Passman and Donna Kerns and Cindy Inman and Jennifer Poirier and James Ebaugh and Joseph Raffetto and David Chew and Subhash Lathi and Christopher Owens and Kathleen Hickson and Dosluoglu, {Hasan H.} and Karen Eschberger and Kibbe, {Melina R.} and Baraniewski, {Henry M.} and Jon Matsumura and Michelle Endo and Anna Busman and Wendy Meadows and Mary Evans and Giglia, {Joseph S.} and {El Sayed}, Hosam and Reed, {Amy B.} and Madeline Ruf and Stephanie Ross and Jean-Claude, {Jessie M.} and Gilles Pinault and Preet Kang and Nadine White and Matthew Eiseman and Reba Jones and Timaran, {Carlos H.} and {Gregory Modrall}, J. and {Burress Welborn}, M. and Jorge Lopez and Tammy Nguyen and Chacko, {John K Y} and Kenneth Granke and Vouyouka, {Angela G.} and Erin Olgren and Prakash Chand and Brenda Allende and Michael Ranella and Claudia Yales and Whitehill, {Thomas A.} and Krupski, {William C.} and Nehler, {Mark R.} and Johnson, {Stephen P.} and Jones, {Darrell N.} and Pamela Strecker and Bhola, {Michelle A.} and Shortell, {Cynthia K.} and Gray, {John L.} and Lawson, {Jeffrey H.} and Richard McCann and Sebastian, {Mark W.} and Tetterton, {Jean Kistler} and Carla Blackwell and Prinzo, {Patricia A.} and Nina Lee and Padberg, {Frank T.} and Cerveira, {Joaquim J.} and Zickler, {Robert W.} and Hauck, {Karen A.} and Berceli, {Scott A.} and {Anthony Lee}, W. and {Keith Ozaki}, C. and Nelson, {Peter R.} and Irwin, {Anne S.} and Randy Baum and Bernadette Aulivola and Heron Rodriguez and Littooy, {Fred N.} and Howard Greisler and O'Sullivan, {Mary T.} and Panagiotis Kougias and Lin, {Peter H.} and Bush, {Ruth L.} and Gene Guinn and Carlos Bechara and Catherine Cagiannos and George Pisimisis and Neal Barshes and Sherilyn Pillack and Barbara Guillory and Dolores Cikrit and Lalka, {Stephen G.} and Gary Lemmon and Ryan Nachreiner and Mitzi Rusomaroff and Elaine O'Brien and Cullen, {Joseph J.} and Jamal Hoballah and {John Sharp}, W. and McCandless, {Jeanne L.} and Vickie Beach and David Minion and Schwarcz, {Thomas H.} and Joy Kimbrough and Laura Ashe and Anna Rockich and Jill Warner-Carpenter and Mohammed Moursi and Eidt, {John F.} and Sandra Brock and Christian Bianchi and Vicki Bishop and Gordon, {Ian L.} and Roy Fujitani and Kubaska, {Stephen M.} and Mina Behdad and Reza Azadegan and Christine Maagas and Kathy Zalecki and Hoch, {John R.} and Carr, {Sandra C.} and Charles Acher and Margaret Schwarze and Girma Tefera and Matthew Mell and Beth Dunlap and Janice Rieder and Stuart, {John M.} and Weiman, {Darryl S.} and Omran Abul-Khoudoud and {Edward Garrett}, H. and Walsh, {Sandra M.} and Wilson, {Karen L.} and Seabrook, {Gary R.} and Cambria, {Robert A.} and Brown, {Kellie R.} and Lewis, {Brian D.} and Susan Framberg and Christa Kallio and Barke, {Roderick A.} and Santilli, {Steven M.} and D'Audiffret, {Alexandre C.} and Nancy Oberle and Catherine Proebstle and Johnson, {Lauri Lee} and Jacobowitz, {Glenn R.} and Neal Cayne and Caron Rockman and Mark Adelman and Paul Gagne and Matthew Nalbandian and Caropolo, {Leah J.} and Pipinos, {Iraklis I.} and Jason Johanning and Thomas Lynch and {De Spiegelaere}, Holly and Georgia Purviance and Wei Zhou and Ronald Dalman and Lee, {Jason T.} and Bassem Safadi and Coogan, {Sheila M.} and Wren, {Sherry M.} and Bahmani, {Doghdoo D.} and Deanna Maples and Shawna Thunen and Golden, {Michael A.} and Mitchell, {Marc E.} and Ronald Fairman and Sally Reinhardt and Wilson, {Mark A.} and Edith Tzeng and Satish Muluk and Peterson, {Nina M.} and Maria Foster and James Edwards and Moneta, {Gregory (Greg)} and Gregory Landry and Lloyd Taylor and Richard Yeager and Eleanor Cannady and Gerald Treiman and Stephanie Hatton-Ward and Barbara Salabsky and Nikhil Kansal and Erik Owens and Melanie Estes and Forbes, {Beth A.} and Cinda Sobotta and Rapp, {Joseph H.} and Reilly, {Linda M.} and Perez, {Sandra L.} and Kimberly Yan and Rajaabrata Sarkar and Dwyer, {Shelley S.} and Karen Chong and Kohler, {Ted R.} and Hatsukami, {Thomas S.} and Glickerman, {David G.} and Michael Sobel and Burdick, {Thomas S.} and Kimberly Pedersen and Patricia Cleary and Martin Back and Dennis Bandyk and Brad Johnson and Murray Shames and Reinhard, {Rebecca L.} and Thomas, {Sandra C.} and Hunter, {Glenn C.} and Leon, {Luis R.} and Alex Westerband and Guerra, {Robert J.} and Macario Riveros and Mills, {John L.} and Hughes, {John D.} and Escalante, {Andrea M.} and Psalms, {Shemuel B.} and Day, {Nancy N.} and Robyn Macsata and Anton Sidawy and Jonathan Weiswasser and Subodh Arora and Jasper, {Brenda J.} and Alan Dardik and Vivian Gahtan and Muhs, {Bart E.} and Sumpio, {Bauer E.} and Gusberg, {Richard J.} and Marcelo Spector and Jeffrey Pollak and John Aruny and {Lynne Kelly}, E. and James Wong and Penny Vasilas and Carmelene Joncas and Gelabert, {Hugh A.} and {De Virgillio}, Christian and Rigberg, {David A.} and Loretta Cole and Elizabeth Latts and Swanson, {Kathleen M.} and Johnson, {Gary R.} and Peter Guarino and Peter Peduzzi and Margaret Antonelli and Cindy Cushing and Elizabeth Davis and Lynn Durant and Shirley Joyner and Alice Kossack and {Le Gwin}, Mary and Vanessa McBride and Terry O'Connor and June Poulton and Susan Stratton and Scott Zellner and Snodgrass, {Amanda J.} and Julie Thornton and Haakenson, {Clair M.} and Yvonne Jonk and Hallett, {John W.} and Norman Hertzer and Jonathan Towne and Katz, {David A.} and Theodore Karrison and Matts, {John P.} and Richard Marottoli and Stanislav Kasl and Rajni Mehta and Richard Feldman and William Farrell and Heather Allore and Edward Perry and James Niederman and Randall, {Sister Frances} and Zeman, {Reverend Michael} and Donald Beckwith and O'Leary, {Timothy J.} and Huang, {Grant D.} and Marilyn Bader",
    year = "2016",
    month = "12",
    day = "1",
    doi = "10.1001/jamasurg.2016.2783",
    language = "English (US)",
    volume = "151",
    pages = "1139--1144",
    journal = "JAMA Surgery",
    issn = "2168-6254",
    publisher = "American Medical Association",
    number = "12",

    }

    TY - JOUR

    T1 - Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm

    T2 - A randomized clinical trial

    AU - Lederle, Frank A.

    AU - Stroupe, Kevin T.

    AU - Kyriakides, Tassos C.

    AU - Ge, Ling

    AU - Freischlag, Julie A.

    AU - Ketteler, Erika R.

    AU - Kingsley, Darra D.

    AU - Marek, John M.

    AU - Massen, Richard J.

    AU - Matteson, Brian D.

    AU - David Pitcher, J.

    AU - Langsfeld, Mark

    AU - Corson, John D.

    AU - Goff, James M.

    AU - Kasirajan, Karthnik

    AU - Paap, Christina

    AU - Robertson, Diane C.

    AU - Salam, Atef

    AU - Veeraswamy, Ravi

    AU - Milner, Ross

    AU - Kasirajan, Karthikeshwar

    AU - Guidot, Jane

    AU - Lal, Brajesh K.

    AU - Busuttil, Steven J.

    AU - Lilly, Michael P.

    AU - Braganza, Melita

    AU - Ellis, Kea

    AU - Patterson, Mark A.

    AU - Jordan, William D.

    AU - Whitley, David

    AU - Taylor, Steve

    AU - Passman, Marc

    AU - Kerns, Donna

    AU - Inman, Cindy

    AU - Poirier, Jennifer

    AU - Ebaugh, James

    AU - Raffetto, Joseph

    AU - Chew, David

    AU - Lathi, Subhash

    AU - Owens, Christopher

    AU - Hickson, Kathleen

    AU - Dosluoglu, Hasan H.

    AU - Eschberger, Karen

    AU - Kibbe, Melina R.

    AU - Baraniewski, Henry M.

    AU - Matsumura, Jon

    AU - Endo, Michelle

    AU - Busman, Anna

    AU - Meadows, Wendy

    AU - Evans, Mary

    AU - Giglia, Joseph S.

    AU - El Sayed, Hosam

    AU - Reed, Amy B.

    AU - Ruf, Madeline

    AU - Ross, Stephanie

    AU - Jean-Claude, Jessie M.

    AU - Pinault, Gilles

    AU - Kang, Preet

    AU - White, Nadine

    AU - Eiseman, Matthew

    AU - Jones, Reba

    AU - Timaran, Carlos H.

    AU - Gregory Modrall, J.

    AU - Burress Welborn, M.

    AU - Lopez, Jorge

    AU - Nguyen, Tammy

    AU - Chacko, John K Y

    AU - Granke, Kenneth

    AU - Vouyouka, Angela G.

    AU - Olgren, Erin

    AU - Chand, Prakash

    AU - Allende, Brenda

    AU - Ranella, Michael

    AU - Yales, Claudia

    AU - Whitehill, Thomas A.

    AU - Krupski, William C.

    AU - Nehler, Mark R.

    AU - Johnson, Stephen P.

    AU - Jones, Darrell N.

    AU - Strecker, Pamela

    AU - Bhola, Michelle A.

    AU - Shortell, Cynthia K.

    AU - Gray, John L.

    AU - Lawson, Jeffrey H.

    AU - McCann, Richard

    AU - Sebastian, Mark W.

    AU - Tetterton, Jean Kistler

    AU - Blackwell, Carla

    AU - Prinzo, Patricia A.

    AU - Lee, Nina

    AU - Padberg, Frank T.

    AU - Cerveira, Joaquim J.

    AU - Zickler, Robert W.

    AU - Hauck, Karen A.

    AU - Berceli, Scott A.

    AU - Anthony Lee, W.

    AU - Keith Ozaki, C.

    AU - Nelson, Peter R.

    AU - Irwin, Anne S.

    AU - Baum, Randy

    AU - Aulivola, Bernadette

    AU - Rodriguez, Heron

    AU - Littooy, Fred N.

    AU - Greisler, Howard

    AU - O'Sullivan, Mary T.

    AU - Kougias, Panagiotis

    AU - Lin, Peter H.

    AU - Bush, Ruth L.

    AU - Guinn, Gene

    AU - Bechara, Carlos

    AU - Cagiannos, Catherine

    AU - Pisimisis, George

    AU - Barshes, Neal

    AU - Pillack, Sherilyn

    AU - Guillory, Barbara

    AU - Cikrit, Dolores

    AU - Lalka, Stephen G.

    AU - Lemmon, Gary

    AU - Nachreiner, Ryan

    AU - Rusomaroff, Mitzi

    AU - O'Brien, Elaine

    AU - Cullen, Joseph J.

    AU - Hoballah, Jamal

    AU - John Sharp, W.

    AU - McCandless, Jeanne L.

    AU - Beach, Vickie

    AU - Minion, David

    AU - Schwarcz, Thomas H.

    AU - Kimbrough, Joy

    AU - Ashe, Laura

    AU - Rockich, Anna

    AU - Warner-Carpenter, Jill

    AU - Moursi, Mohammed

    AU - Eidt, John F.

    AU - Brock, Sandra

    AU - Bianchi, Christian

    AU - Bishop, Vicki

    AU - Gordon, Ian L.

    AU - Fujitani, Roy

    AU - Kubaska, Stephen M.

    AU - Behdad, Mina

    AU - Azadegan, Reza

    AU - Maagas, Christine

    AU - Zalecki, Kathy

    AU - Hoch, John R.

    AU - Carr, Sandra C.

    AU - Acher, Charles

    AU - Schwarze, Margaret

    AU - Tefera, Girma

    AU - Mell, Matthew

    AU - Dunlap, Beth

    AU - Rieder, Janice

    AU - Stuart, John M.

    AU - Weiman, Darryl S.

    AU - Abul-Khoudoud, Omran

    AU - Edward Garrett, H.

    AU - Walsh, Sandra M.

    AU - Wilson, Karen L.

    AU - Seabrook, Gary R.

    AU - Cambria, Robert A.

    AU - Brown, Kellie R.

    AU - Lewis, Brian D.

    AU - Framberg, Susan

    AU - Kallio, Christa

    AU - Barke, Roderick A.

    AU - Santilli, Steven M.

    AU - D'Audiffret, Alexandre C.

    AU - Oberle, Nancy

    AU - Proebstle, Catherine

    AU - Johnson, Lauri Lee

    AU - Jacobowitz, Glenn R.

    AU - Cayne, Neal

    AU - Rockman, Caron

    AU - Adelman, Mark

    AU - Gagne, Paul

    AU - Nalbandian, Matthew

    AU - Caropolo, Leah J.

    AU - Pipinos, Iraklis I.

    AU - Johanning, Jason

    AU - Lynch, Thomas

    AU - De Spiegelaere, Holly

    AU - Purviance, Georgia

    AU - Zhou, Wei

    AU - Dalman, Ronald

    AU - Lee, Jason T.

    AU - Safadi, Bassem

    AU - Coogan, Sheila M.

    AU - Wren, Sherry M.

    AU - Bahmani, Doghdoo D.

    AU - Maples, Deanna

    AU - Thunen, Shawna

    AU - Golden, Michael A.

    AU - Mitchell, Marc E.

    AU - Fairman, Ronald

    AU - Reinhardt, Sally

    AU - Wilson, Mark A.

    AU - Tzeng, Edith

    AU - Muluk, Satish

    AU - Peterson, Nina M.

    AU - Foster, Maria

    AU - Edwards, James

    AU - Moneta, Gregory (Greg)

    AU - Landry, Gregory

    AU - Taylor, Lloyd

    AU - Yeager, Richard

    AU - Cannady, Eleanor

    AU - Treiman, Gerald

    AU - Hatton-Ward, Stephanie

    AU - Salabsky, Barbara

    AU - Kansal, Nikhil

    AU - Owens, Erik

    AU - Estes, Melanie

    AU - Forbes, Beth A.

    AU - Sobotta, Cinda

    AU - Rapp, Joseph H.

    AU - Reilly, Linda M.

    AU - Perez, Sandra L.

    AU - Yan, Kimberly

    AU - Sarkar, Rajaabrata

    AU - Dwyer, Shelley S.

    AU - Chong, Karen

    AU - Kohler, Ted R.

    AU - Hatsukami, Thomas S.

    AU - Glickerman, David G.

    AU - Sobel, Michael

    AU - Burdick, Thomas S.

    AU - Pedersen, Kimberly

    AU - Cleary, Patricia

    AU - Back, Martin

    AU - Bandyk, Dennis

    AU - Johnson, Brad

    AU - Shames, Murray

    AU - Reinhard, Rebecca L.

    AU - Thomas, Sandra C.

    AU - Hunter, Glenn C.

    AU - Leon, Luis R.

    AU - Westerband, Alex

    AU - Guerra, Robert J.

    AU - Riveros, Macario

    AU - Mills, John L.

    AU - Hughes, John D.

    AU - Escalante, Andrea M.

    AU - Psalms, Shemuel B.

    AU - Day, Nancy N.

    AU - Macsata, Robyn

    AU - Sidawy, Anton

    AU - Weiswasser, Jonathan

    AU - Arora, Subodh

    AU - Jasper, Brenda J.

    AU - Dardik, Alan

    AU - Gahtan, Vivian

    AU - Muhs, Bart E.

    AU - Sumpio, Bauer E.

    AU - Gusberg, Richard J.

    AU - Spector, Marcelo

    AU - Pollak, Jeffrey

    AU - Aruny, John

    AU - Lynne Kelly, E.

    AU - Wong, James

    AU - Vasilas, Penny

    AU - Joncas, Carmelene

    AU - Gelabert, Hugh A.

    AU - De Virgillio, Christian

    AU - Rigberg, David A.

    AU - Cole, Loretta

    AU - Latts, Elizabeth

    AU - Swanson, Kathleen M.

    AU - Johnson, Gary R.

    AU - Guarino, Peter

    AU - Peduzzi, Peter

    AU - Antonelli, Margaret

    AU - Cushing, Cindy

    AU - Davis, Elizabeth

    AU - Durant, Lynn

    AU - Joyner, Shirley

    AU - Kossack, Alice

    AU - Le Gwin, Mary

    AU - McBride, Vanessa

    AU - O'Connor, Terry

    AU - Poulton, June

    AU - Stratton, Susan

    AU - Zellner, Scott

    AU - Snodgrass, Amanda J.

    AU - Thornton, Julie

    AU - Haakenson, Clair M.

    AU - Jonk, Yvonne

    AU - Hallett, John W.

    AU - Hertzer, Norman

    AU - Towne, Jonathan

    AU - Katz, David A.

    AU - Karrison, Theodore

    AU - Matts, John P.

    AU - Marottoli, Richard

    AU - Kasl, Stanislav

    AU - Mehta, Rajni

    AU - Feldman, Richard

    AU - Farrell, William

    AU - Allore, Heather

    AU - Perry, Edward

    AU - Niederman, James

    AU - Randall, Sister Frances

    AU - Zeman, Reverend Michael

    AU - Beckwith, Donald

    AU - O'Leary, Timothy J.

    AU - Huang, Grant D.

    AU - Bader, Marilyn

    PY - 2016/12/1

    Y1 - 2016/12/1

    N2 - IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

    AB - IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

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    U2 - 10.1001/jamasurg.2016.2783

    DO - 10.1001/jamasurg.2016.2783

    M3 - Article

    C2 - 27627802

    AN - SCOPUS:85011408066

    VL - 151

    SP - 1139

    EP - 1144

    JO - JAMA Surgery

    JF - JAMA Surgery

    SN - 2168-6254

    IS - 12

    ER -