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Challenges in analysis and interpretation of cost data in vascular surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Medical Management Centre, Karolinska Institutet.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2010 (English)In: Journal of vascular surgery, ISSN 0741-5214, Vol. 51, no 1, 148-154 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Health economic arguments have become increasingly important in clinical decision making, especially when new treatment modalities are introduced. This study reviews the methods used in health economic reports of abdominal aortic aneurysm (AAA) repair and uses original cost data to study how different methods affect interpretation of results in terms of cost differences and economic efficiency. DESIGN: Publications referenced in PubMed from 2003 to 2008 studying cost of AAA repair were reviewed. Original population-based cost data of AAA repair were analyzed, comparing open (OR) and endovascular repair (EVAR). Means, medians, and cost distributions were calculated, and differences were analyzed with four different statistical methods. RESULTS: The review showed a mixture of statistical methods used in AAA treatment cost-comparison studies. Presentation of cost data and inclusion criteria varied between studies. The analysis of original data showed skewed distribution of cost data, with large differences between mean and median cost. Although mean values indicated a lower total, perioperative, and postoperative cost for EVAR, the median values indicated OR was the least costly method. Exclusion of extreme values lowered mean perioperative cost of OR by 10%, while cost of EVAR was unaffected. Inferential testing of cost differences by means of four statistical methods showed that P values were highly dependent on test methodology. CONCLUSIONS: Conclusions of health economic reports can be highly dependent on how the data are presented and the statistical methods that are used. We recommend that cost data be presented as mean values with distributions. Exclusion of outliers and focus on P values should be avoided.

Place, publisher, year, edition, pages
2010. Vol. 51, no 1, 148-154 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-110809DOI: 10.1016/j.jvs.2009.08.042ISI: 000273708500027PubMedID: 19889511OAI: oai:DiVA.org:uu-110809DiVA: diva2:278415
Available from: 2009-11-25 Created: 2009-11-25 Last updated: 2011-12-19Bibliographically approved
In thesis
1. Abdominal Aortic Aneurysm: Epidemiological and Health Economic Aspects
Open this publication in new window or tab >>Abdominal Aortic Aneurysm: Epidemiological and Health Economic Aspects
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abdominal aortic aneurysm (AAA) is a common disease that is life threatening when rupture occurs. The aims of this thesis were to study (I) the long-term survival after AAA repair, (II) the cost of repair with open (OR) and endovascular (EVAR) technique, (III) the effect of different statistical methods on interpretation of cost data, (IV) the prevalence of the disease among patients with suspected arterial disease referred to the vascular laboratory, and (V) the cost-effectiveness of selective high-risk screening. Analyses of data from the Swedish vascular registry (Swedvasc), local patient registries, patient records and hospital cost registries form the basis of this thesis.

Short- and long-term survival after intact AAA repair improved over the past two decades, despite increasing patient age and rate of comorbidities over time. Compared to a general population adjusted for age, sex and calendar year, the relative 5-year survival was 90% among those surviving repair. While short-term survival improved over time after ruptured repair, relative long-term survival was stable. Despite differences in patient selection and cost structure, the total cost of AAA repair with EVAR and OR was similar in a population based setting (€28,193). There was lack of consistency in the methods used in cost-analysis in the current literature, and p-values were highly dependent on test method.

The practice of selective (non-population-based) screening for AAA among patients referred to the vascular laboratory was studied. The prevalence of AAA was 4.2% among male and 1.5% among female patients. AAA was associated with high age and prevalence of arterial stenosis. Of AAAs detected through selective screening, 21.5% had undergone elective repair at 7.5 years follow-up. In a health-economic evaluation, the incremental cost-effectiveness ratio of selective screening was €11,084 per life year gained.

In conclusion, survival after intact AAA repair has improved over time, despite changes in case-mix. Results of health economic reports on cost of AAA repair can be highly dependent on patient selection as well as presentation of data and the statistical methods used. Selective screening for AAA among patients referred to the vascular laboratory is cost-effective.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 86 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 503
Keyword
Abdominal aortic aneurysm, cost, cost-effectiveness, endovascular aneurysm repair, screening, surgery, survival
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-110810 (URN)978-91-554-7670-0 (ISBN)
Public defence
2010-02-19, Auditorium Minus, Museum Gustavianum, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2009-12-18 Created: 2009-11-25 Last updated: 2010-02-05Bibliographically approved

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Mani, KevinHolmberg, LarsWanhainen, Anders

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