FINANCIAL IMPLICATIONS OF TECHNOLOGICAL ADAPTATION: THE BURDEN OF ENDOVASCULAR AORTIC ANEURYSM REPAIR DEVICE COST ON HOSPITAL FINANCES

OBJECTIVES: Since the FDA approval of endovascular aortic aneurysm repair (EVAR) devices, there has been a gradual transition from a physiologic to an anatomic criteria in patient selection for EVAR. The objective of this study is to investigate the financial implications of EVAR compared to OPEN abdominal aortic aneurysms (AAA) repair on hospitals.
METHODS: A retrospective analysis was performed reviewing all patients who underwent EVAR between 2005-2007. A subset of OPEN cases was identified to serve as a control group. Electronic records, including clinical, demographic and financial variables, of all cases were systematically reviewed. The primary endpoint was defined as contribution margin. A financial model of linear reduction on EVAR device costs was created to analyze endpoint associated variables. Data was analyzed with univariate measures.
RESULTS: Over the study period, 139 AAA repair procedures were identified, 78% (n=109) EVAR and 22% (n=30) OPEN. Mean patient age was 72.2 ± 0.8 years (range 36-92 years). There were no significant differences between treatment groups regarding co-morbidities, preoperative pharmacotherapy and aortic aneurysm size. There was a significantly lower length of stay in the EVAR group compared to OPEN (3.00 ± 0.30 days EVAR, 11.97 ± 3.86 days OPEN, P< 0.01). Financial analysis was limited to non-ruptured AAA repair (82%, n=101 EVAR; 18%, n=22 OPEN) to accurately assess elective AAA repair. Significant differences between groups were found in direct cost, total cost, total payment, contribution margin ($6,320.02 ± 881.92 EVAR, $20,168.81 ± 2800.90 OPEN, P< 0.05) and device cost ratio (68% ± 1.3% EVAR, 5.1% ± 0.6% OPEN, P< 0.01). The financial model demonstrated a 51% reduction in endovascular device cost is necessary to equilibrate the contribution margin between treatment groups.
CONCLUSIONS: Despite decreased length of stay, EVAR yields a significantly lower contribution margin compared to OPEN. Significant device cost reduction is required to alleviate this difference. Current widespread adoption of EVAR, based largely on anatomic factors, has a deleterious effect on hospital finances.