Impact of Endograft Design and Product Line on the Device Cost of EVAR

Objectives: Device cost is a substantial component of the overall cost of endovascular repair of abdominal aortic aneurysms (EVAR). The 3 major commercially-available devices differ significantly in their configuration overall design configuration (bimodular vs. trimodular), which impacts the overall device costs.
Methods: Device implant records of all EVAR procedures (N=467) using the Medtronic AneuRx (N=178, 38.1%), Gore Excluder (N=123, 26.3%), and Cook Zenith (N=166, 35.5%) performed during 2000-2006 were reviewed. The specific device was chosen for each case was based upon its commercial availability, patient anatomy, and surgeon preference. The principles of EVAR remained constant during the study period.
Results: The minimal cost per case differed by $3,022 with Zenith being the most expensive. AneuRx required the most number of extensions (N=339, 1.90 ± 1.25 per case, range 0-7); Zenith required the fewest (N=35, 0.21 ± 0.51 per case, range 0-3). When the costs of the extensions were added, the total mean device costs per case were similar.
Conclusions: The theoretical cost advantage for the AneuRx and Excluder devices are negated by the more frequent need for proximal and distal extensions to achieve adequate repair when these devices are used for EVAR. The device cost should not factor into the decision to select one specific device over another.