Thoracic endovascular aortic repair was substantially more cost effective at 1 year compared with open repair in a hypothetical cohort of patients with acute complicated type B aortic dissection.
The researchers evaluated the costs and benefits associated with the two strategies with the aim of estimating the cost effectiveness. They used a decision analytic model from the perspective of the health payer system to assess the optimal treatment method.
Outcome measures included 1-year survival, quality-adjusted life-years and costs for a hypothetical group of patients with acute type B aortic dissection who had been managed with one of the two treatment approaches.
The researchers reviewed prior data from studies and meta-analyses to determine clinical effectiveness data, cost data and transitional probabilities of different health states. They performed probabilistic sensitivity analyses on uncertain model parameters.
Open repair was determined to be the more expensive therapy in terms of quality-adjusted life-years in a best-case analysis. This strategy yielded an incremental cost of 17,252.60 euros. Open repair also was less effective than thoracic endovascular aortic repair (TEVAR), with –0.19 quality-adjusted life-years.
“Hence, in terms of the incremental cost-effectiveness ratio, [open repair] was dominated by TEVAR,” the researchers wrote. Because of this, they did not calculate the incremental cost-effectiveness ratio, which they defined as the cost per life-year saved.
TEVAR was associated with an average cost-effectiveness ratio per quality-adjusted life-year gained of 56,316.79 euros compared with 108,421.91 euros for open repair.
Results of a probabilistic sensitivity analysis demonstrated that the thoracic approach was economically dominant 100% of the time. There was a 100% probability that TEVAR would be the economically preferable strategy at a willingness-to-pay threshold of 50,000 euros per quality-adjusted life-year gained.
The researchers concluded that TEVAR is preferable to open repair in patients with acute type B aortic dissection who meet the predefined conditions of the study protocol.
Disclosure: The researchers report no relevant financial disclosures.