Australia & New Zealand Society of Vascular Surgeons

The device cost for an Endoluminal aortic graft (EAG) has been the major reason given for public hospitals restricting the use of the graft for abdominal aortic aneurysm exclusion in place of open aortic grafting (OAG). To investigate the cost difference between the 2 procedures, 34 consecutive patients underwent replacement of an infrarenal abdominal aortic aneurysm between August 1998 and October 1999 in a major rural hospital. The patients were catagorised into 3 groups. Group 1: EAGs performed in patients selected as high-risk for open aortic replacement (n = 14); Group 2 : OAGs performed in patients deemed unsuitable for EAG due to aneurysm morphology (n = 9); Group 3 : OAGs performed in patients whose aneurysms were assessed as otherwise suitable for EAG on the preoperative CT scan (n = 11). Outcome factors were analyzed for all 34 patients and detailed in-hospital cost-analysis performed for each procedure. Most OAG patients had an uncomplicated course and this was the most economical procedure, averaging $10276 for in-hospital costs (n = 13). The average cost for an EAG was $17171 (there were few complications in this group) and this compared well with the average cost for an OAG with non-major complications at $15804 (n = 4). An OAG with a major complication was the most expensive at an average cost of $19857 (n = 3). The in-hospital cost of EAGs for abdominal aortic aneurysm compares well with OAGs where complications occur and therefore is an economical alternative in the high-risk patient, however pre- and post-hospital radiology adds to the cost of the EAGs.