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.