Impact of endograft design and product line on the device cost of endovascular aneurysm repair
Presented at the Thirty-fifth Annual Symposium of Society for Clinical Vascular Surgery, Orlando, Fla, Mar 21-24, 2007.
Received 17 July 2007; accepted 27 October 2007.
Objective
Device cost is a substantial component of the overall cost of endovascular abdominal aneurysm repair (EVAR), and the four commercially available devices differ significantly in the cost of their basic configuration. This study examined the impact of three different endografts and their product lines on the overall cost of repair.
Methods
Implant records of 467 EVAR procedures performed during 2000 through 2006 were reviewed. The three devices used were the AneuRx in 178 (38.1%; Medtronic, Santa Rosa, Ca), the Excluder in 123 (26.3%; W. L. Gore & Associates, Flagstaff, Ariz), and the Zenith in 166 (35.5%; the Cook Zenith (Bloomington, Ind). The Powerlink device (Endologix, Irvine, Calif) was not studied. The specific device implanted was determined by its commercial availability at the time of repair, patient anatomy, and surgeon preference. Retail list prices were used for all calculations, and only devices used during the original repair were used for analysis.
Results
The device cost of the most basic configuration for repair (ie, 2 pieces for AneuRx and Excluder, 3 pieces for Zenith) differed by $3022 between the most expensive (Zenith) to the least expensive (AneuRx). However, the AneuRx system required the most number of extensions (1.90 ± 1.25 per case; range, 0-7), whereas the Zenith required the fewest (0.21 ± 0.51 per case; range, 0-3). When the costs of the extensions were added, the overall mean device costs per case were similar.
Conclusion
The initial cost advantage of the AneuRx and Excluder endograft systems were offset by the more frequent need for proximal and distal extensions. The minimum device cost of a basic repair should not factor into the decision to select one specific device over another because additional devices may be required depending on the design and construction of the endograft system and the accuracy and reliability of their deployment mechanisms.
Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla.
Correspondence: W. Anthony Lee, MD, Division of Vascular Surgery and Endovascular Therapy, University of Florida, PO Box 100286, Gainesville, FL 32610-0286.
Competition of interest: Dr Lee is a consultant for Cook and Medtronic.
ABSTRACT