Evolution of the cost-effectiveness of endovascular and open surgical repair of abdominal aortic aneurysms

A cost-effectiveness analysis refers to the economic study in which consequences of distinct interventions are evaluated using a single outcome. In healthcare, these analysis measure ‘natural’ units, such as life-years gained or deaths avoided, and are used to either compare alternative programs with a common health outcome or assess the consequences of expanding an existing program. Commonly, costeffectiveness results are used to support decisions regarding the adoption of medical devices, coverage of treatments or their reimbursement rate [1]. It is commonly accepted that, with time, experience increases as well as success rates and, on the other hand, costs decrease due to economies of scale or the maturation of technologies. However, there is uncertainty regarding the applicability of these assumptions to medical procedures involving medical devices. Here, we study the evolution of the cost-effectiveness of endovascular abdominal aortic aneurysm repair versus the conventional treatment, open surgery. Contrary to what was expected, the effectiveness decreases and costs increase along the time. If this behavior is similar in other procedures, one can question the applicability of cost-effectiveness analysis to support decisions involving medical devices.