Costs of endovascular and open repair of thoracic aortic aneurysms

Background Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up.Methods A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged >= 18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken. A multicentre prospective cost analysis of patients (recruited March 2014-July 2018, follow-up until July 2019) undergoing TEVAR or OSR was performed. Patients deemed suitable for open or endovascular repair were included in this study. A micro-costing approach was adopted.Results Some 115 patients having undergone TEVAR and 35 patients with OSR were identified. The mean (s.d.) cost of a TEVAR procedure was higher 26 pound 536 (9877) pound versus OSR 17 pound 239 (8043) pound. Postoperative costs until discharge were lower for TEVAR 7484 pound (7848) pound versus OSR 28 pound 636 (23 pound 083). Therefore, total NHS costs from admission to discharge were lower for TEVAR 34 pound 020 (14 pound 301), versus OSR 45 pound 875 (43 pound 023). However, mean NHS costs for 12 months following the procedure were slightly higher for the TEVAR 5206 pound (11 pound 585) versus OSR 5039 pound (11 pound 994).Conclusions Surgical procedure costs were higher for TEVAR due to device costs. Total in-hospital costs were higher for OSR due to longer hospital and critical care stay. Follow-up costs over 12 months were slightly higher for TEVAR due to hospital readmissions. Detailed micro-costing of endovascular stent grafting (TEVAR) and open surgical repair (OSR) in a cohort of UK NHS patients for whole of treatment pathway up to 12 months follow-up. Overall costs are higher for OSR, driven by length of stay and critical care post-procedure, compared to TEVAR, with costs driven by stent graft devices. These detailed micro-costing estimates exceed current NHS tariffs for reimbursement.