• Kate C Young, Nadia A Awad, Marcia Johansson, David Gillespie, Michael J Singh, and Karl A Illig.
• Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. kate_young@urmc.rochester.edu
• J. Vasc. Surg. 2010 Jan 1; 51 (1): 27-32; discussion 32.

ObjectiveTo evaluate the cost-effectiveness of endovascular repair (EVAR) for small abdominal aortic aneurysms (AAA).MethodsWe developed a Markov model of a hypothetical 68-year-old cohort to determine the cost-effectiveness of early EVAR for "small" AAAs (4.0 cm-5.4 cm) compared with elective repair (open or endovascular) at the traditional cut-off of 5.5 cm. Repair options for 5.5-cm AAAs include both endovascular and open procedures. Probabilities were obtained from the literature. Costs reflected direct costs in 2007 dollars. Outcomes were reported as quality-adjusted life-years (QALYs).ResultsThe model demonstrated that early EVAR for 4.0 cm-5.4 cm AAAs led to fewer QALYs at greater costs when compared with observational management with elective repair at 5.5 cm. Sensitivity analyses suggested that early EVAR of 4.6 cm-4.9 cm AAAs can be cost-effective if the long-term mortality rate after EVAR is or=4.6 cm may be cost-effective. With a >70% probability, observational management until AAA diameter is 5.5 cm will be the cost-effective option.ConclusionsThis analysis demonstrated that early EVAR for AAAs <5.5 cm is not likely to be cost-effective compared with elective repair at 5.5 cm. However, EVAR for small AAAs may become cost-effective when differences in quality of life and mortality are considered.Copyright 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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