An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients
**Objectives:** We examined patient-specific predictors of high cost for endovascular (EVAR) and open (OPEN) repair of abdominal aortic aneurysm (AAA). **Methods:** Vascular Study Group of Northern New England data specific to Fletcher Allen Health Care were merged with cost data from the same sour...
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| Format: | Article |
| Language: | English |
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Columbia Data Analytics, LLC
2014-02-01
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| Series: | Journal of Health Economics and Outcomes Research |
| Online Access: | https://jheor.org/article/9876-an-algorithm-to-analyze-cost-heterogeneity-using-counterfactual-scenarios-in-endovascular-versus-open-repair-of-abdominal-aortic-aneurysm-predicting |
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| author | Christopher A. Jones Peter W. Callas Robert W. Everett Richard A. Galbraith Richie Spitsberg Jeffrey J. Petrozzino Michael J. DeSarno Andrew C. Stanley |
| author_facet | Christopher A. Jones Peter W. Callas Robert W. Everett Richard A. Galbraith Richie Spitsberg Jeffrey J. Petrozzino Michael J. DeSarno Andrew C. Stanley |
| author_sort | Christopher A. Jones |
| collection | DOAJ |
| description | **Objectives:** We examined patient-specific predictors of high cost for endovascular (EVAR) and open (OPEN) repair of abdominal aortic aneurysm (AAA).
**Methods:** Vascular Study Group of Northern New England data specific to Fletcher Allen Health Care were merged with cost data from the same source. We retrospectively analyzed 389 elective AAA repairs (230 EVAR, 159 OPEN) between 2003 and 2011 to determine clinical characteristics that contribute to membership in the upper quartile of cost (UQC) versus the remaining three quartiles. For the purpose of this exercise, it was assumed that clinical outcomes were equally good with EVAR versus OPEN repair.
**Results:** Significant predictors of UQC for OPEN repair procedures were: history of treated chronic obstructive pulmonary disease (COPD), previous bypass surgery, transfer from hospital and age >70 (area under receiver operating curve [ROC] = 0.726). Predictors of UQC for EVAR were: presence of iliac aneurysm(s), coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty within the past 5 years, ejection fraction ≤30%, absence of beta blockers, creatinine ≥1.5mg/dL, and current use of tobacco (area under ROC = 0.784). The mean length of stay for EVAR and OPEN repair were 2.22 and 8.55 days, respectively. Costs for EVAR and OPEN repair were $32,656 (standard error of the mean [SEM] $591) and $28,183 (SEM $1,571), respectively.
**Conclusions:** Certain risk factors at the individual patient level are predictive of UQC. Under such circumstances, it is our expectation that such algorithms may be used to select the most cost-efficient treatment. |
| format | Article |
| id | doaj-art-85c439f883fb4ad3ac95322e649f0430 |
| institution | Kabale University |
| issn | 2327-2236 |
| language | English |
| publishDate | 2014-02-01 |
| publisher | Columbia Data Analytics, LLC |
| record_format | Article |
| series | Journal of Health Economics and Outcomes Research |
| spelling | doaj-art-85c439f883fb4ad3ac95322e649f04302025-02-10T16:12:44ZengColumbia Data Analytics, LLCJournal of Health Economics and Outcomes Research2327-22362014-02-0113An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent PatientsChristopher A. JonesPeter W. CallasRobert W. EverettRichard A. GalbraithRichie SpitsbergJeffrey J. PetrozzinoMichael J. DeSarnoAndrew C. Stanley**Objectives:** We examined patient-specific predictors of high cost for endovascular (EVAR) and open (OPEN) repair of abdominal aortic aneurysm (AAA). **Methods:** Vascular Study Group of Northern New England data specific to Fletcher Allen Health Care were merged with cost data from the same source. We retrospectively analyzed 389 elective AAA repairs (230 EVAR, 159 OPEN) between 2003 and 2011 to determine clinical characteristics that contribute to membership in the upper quartile of cost (UQC) versus the remaining three quartiles. For the purpose of this exercise, it was assumed that clinical outcomes were equally good with EVAR versus OPEN repair. **Results:** Significant predictors of UQC for OPEN repair procedures were: history of treated chronic obstructive pulmonary disease (COPD), previous bypass surgery, transfer from hospital and age >70 (area under receiver operating curve [ROC] = 0.726). Predictors of UQC for EVAR were: presence of iliac aneurysm(s), coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty within the past 5 years, ejection fraction ≤30%, absence of beta blockers, creatinine ≥1.5mg/dL, and current use of tobacco (area under ROC = 0.784). The mean length of stay for EVAR and OPEN repair were 2.22 and 8.55 days, respectively. Costs for EVAR and OPEN repair were $32,656 (standard error of the mean [SEM] $591) and $28,183 (SEM $1,571), respectively. **Conclusions:** Certain risk factors at the individual patient level are predictive of UQC. Under such circumstances, it is our expectation that such algorithms may be used to select the most cost-efficient treatment.https://jheor.org/article/9876-an-algorithm-to-analyze-cost-heterogeneity-using-counterfactual-scenarios-in-endovascular-versus-open-repair-of-abdominal-aortic-aneurysm-predicting |
| spellingShingle | Christopher A. Jones Peter W. Callas Robert W. Everett Richard A. Galbraith Richie Spitsberg Jeffrey J. Petrozzino Michael J. DeSarno Andrew C. Stanley An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients Journal of Health Economics and Outcomes Research |
| title | An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients |
| title_full | An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients |
| title_fullStr | An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients |
| title_full_unstemmed | An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients |
| title_short | An Algorithm to Analyze Cost Heterogeneity using Counterfactual Scenarios in Endovascular versus Open Repair of Abdominal Aortic Aneurysm: Predicting Costs for Subsequent Patients |
| title_sort | algorithm to analyze cost heterogeneity using counterfactual scenarios in endovascular versus open repair of abdominal aortic aneurysm predicting costs for subsequent patients |
| url | https://jheor.org/article/9876-an-algorithm-to-analyze-cost-heterogeneity-using-counterfactual-scenarios-in-endovascular-versus-open-repair-of-abdominal-aortic-aneurysm-predicting |
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