ENDOVASCULAR ANEURYSM REPAIR

Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model

Background

Abdominal aortic aneurysms if left untreated enlarge and eventually rupture with a high mortality. Standard treatment is open surgery (open repair). Repair using endovascular stents (EVAR) is simpler and less invasive. However, long term mortality rates are not necessarily improved with EVAR. This technology assessment investigated the clinical and cost-effectiveness of EVAR compared with open repair.

Findings

The review found that operative mortality benefits of EVAR compared with open repair were not translated into long term benefits and the rate of complications and reintervention was higher with EVAR. Based on the results of this assessment of clinical and cost-effectiveness, open repair should be the treatment of choice for patients with AAA who have good or moderate fitness. For patients with poorer fitness, whether suitable for open repair or not, EVAR may be cost-effective but this will depend upon the patient’s age. EVAR cannot currently be recommended for the treatment of ruptured aneurysms.

Conducted by: D Chambers1, D Epstein2, S Walker2, D Fayter1, F Paton1, K Wright1, J Michaels3, S Thomas3, M Sculpher2, N Woolacott1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York; 3. Academic Vascular Unit, University of Sheffield, Northern General Hospital

Further details

Project page on NIHR HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal 167: Endovascular stent - grafts for the treatment of abdominal aortic aneurysms. London: National Institute for Clinical Excellence; 2009

Publications

Chambers D, Epstein D, Walker S, Fayter D, Paton F, Wright K, Michaels J, Thomas S, Sculpher M, Woolacott N. Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model. Health Technol Assess. 2009; 13(48): 1-214

Chambers D, Fayter D, Paton F, Woolacott N. Use of non-randomised evidence alongside randomised trials in a systematic review of endovascular aneurysm repair: strengths and limitations. Eur J Vasc Endovasc Surg. 2010; 39(1):26-34

Posters

Chambers D, Fayter D, Paton F, Woolacott N, Wright K. Incorporating non-randomised evidence in systematic reviews: a case study. Cochrane Colloquium 2008. Freiburg, Germany, 3 - 7 October 2008

Funding

Commissioned by the NIHR HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process