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Original Articles: Adult Cardiac

Endovascular and Conventional Treatment of Thoracic Aortic Aneurysms: A Comparison of Costs

^a Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
^b Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
^c Department of Controlling and Finance, Medical University of Vienna, Vienna, Austria
^d Department of Interventional Radiology, Medical University of Vienna, Vienna, Austria

Accepted for publication February 20, 2009.

^_* Address reprint requests to Dr Czerny, Waehringer Guertel 18-20, Vienna, A-1090, Austria (Email: martin.czerny{at}meduniwien.ac.at).

Background: The purpose of this study is to compare costs of conventional surgical therapy with costs of endovascular stent-graft placement in patients with thoracic aortic aneurysms.

Methods: Fifteen patients undergoing either conventional surgical therapy or endovascular stent-graft placement of thoracic aortic aneurysms were analyzed. A catalog of costs was then created for both procedures and this catalog was applied individually to each patient.

Results: Total costs of the service provision of endovascular stent-graft placement including anesthesia were 38.220.98 considering 1.7 stent-grafts per patient and including 5900.00 (Euros) for days of care. In conventional surgical therapy, adding the costs of the service provision of left heart catheterization, conventional surgical therapy including anesthesia, as well as intraoperative echocardiography a sum of 19.534.12 was calculated. Days of care accounted for 31.230.00 and total costs of 50.764.12 were calculated. The difference between total costs of the two procedures was 12.543.14.

Conclusions: Costs of endovascular stent-graft placement in patients with thoracic aortic aneurysms compare favorably with conventional surgical therapy, revealing a cost benefit of 24.7%. Higher procedural costs are outweighed by a lower number of days of care. Nevertheless, aneurysm-related secondary endovascular or surgical procedures may balance the benefit of endovascular therapy. Which strategy to choose, conventional or endovascular, should remain to be based on age, comorbidity, and technical feasibility.