Is it difficult to choose
the cost effective mode of treatment for aortic aneurysms after the
introduction of the endovascular therapies for the aneurysms?
The Cost of open and
endovascular repair of the aortic aneurysms is comparable?
It is generally felt that the
Endovascular vascular repairs of the aortic aneurysms is more expensive than
the open repair in India. The duration of the hospital stay and other services
are considered to be less expensive in India than in the other countries. There
are some studies published in the EJVES and JVS saying that the Endovascular
repair may be better than open in terms cost saving! It may be surprising to some of us in India.
The
cost of the Endoprosthesis is more than Rs. 3,50,00 to 10,00,000 depending on
the number of devices and hard ware used during the procedures. The multinational
companies are trying to provide the necessary supports by extending concessions
in some cases.
In many Governments hospitals the surgeons don’t have privileges
to enter the cath labs and at the same these procedures are not supported
financially in government hospitals. So, majority of the cath lab procedures
are done in private sector in our country. There are few govt. general
hospitals performing these procedures maintaining a balance between the cost
and the outcomes. We strongly feel that the Govt. should propose to establish the
cath labs accessible to all the doctors treating the patients through endovascular
methods. There is also need for the hybrid operation theatres to facilitate the
minimally invasive operations to reduce the morbidity and mortality.
VAC study
group from USA says that Endovascular repair is
a cost-effective alternative to open repair in the US VA
healthcare system for at least the first two years Eur J Vasc Endovasc Surg. 2012 Dec;44(6):543-8. Stroupe
KT et al say that In a multicenter randomized trial, endovascular AAA repair
resulted in lower cost and better survival than open repair after the
initial hospitalization for repair; but after 2 years, survival, quality of
life, and costs were not significantly different between the two
treatments. J Vasc Surg. 2012 Oct;56(4):901-9.
Routine use of endovascular repair in patients also eligible for open repair
does not result in a QALY gain at 1 year postoperatively, provides only a
marginal overall survival benefit, and is associated with a substantial, if not
prohibitive, increase in costs. Prinssen M
et al J Vasc Surg. 2007 Nov;46(5):883-890.