{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T09:44:01Z","timestamp":1777801441424,"version":"3.51.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2014,1,27]],"date-time":"2014-01-27T00:00:00Z","timestamp":1390780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Minimally invasive endovascular aneurysm repair (EVAR) could be a surgical technique that improves outcome of patients with ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to analyse the cost-effectiveness and cost\u2013utility of EVAR compared with standard open repair (OR) in the treatment of rAAA, with costs per 30-day and 6-month survivor as outcome parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Resource use was determined from the Amsterdam Acute Aneurysm (AJAX) trial, a multicentre randomized trial comparing EVAR with OR in patients with rAAA. The analysis was performed from a provider perspective. All costs were calculated as if all patients had been treated in the same hospital (Onze Lieve Vrouwe Gasthuis, teaching hospital).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 116 patients were randomized. The 30-day mortality rate was 21 per cent after EVAR and 25 per cent for OR: absolute risk reduction (ARR) 4\u00b74 (95 per cent confidence interval (c.i.) \u201311\u00b70 to 19\u00b77) per cent. At 6 months, the total mortality rate for EVAR was 28 per cent, compared with 31 per cent among those assigned to OR: ARR 2\u00b74 (\u221214\u00b72 to 19\u00b70) per cent. The mean cost difference between EVAR and OR was \u20ac5306 (95 per cent c.i. \u20131854 to 12 659) at 30 days and \u20ac10 189 (\u22122477 to 24 506) at 6 months. The incremental cost-effectiveness ratio per prevented death was \u20ac120 591 at 30 days and \u20ac424 542 at 6 months. There was no significant difference in quality of life between EVAR and OR. Nor was EVAR superior regarding cost\u2013utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>EVAR may be more effective for rAAA, but its increased costs mean that it is unaffordable based on current standards of societal willingness-to-pay for health gains.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bjs.9356","type":"journal-article","created":{"date-parts":[[2014,1,27]],"date-time":"2014-01-27T12:09:10Z","timestamp":1390824550000},"page":"208-215","source":"Crossref","is-referenced-by-count":37,"title":["Cost-effectiveness and cost\u2013utility of endovascular<i>versus<\/i>open repair of ruptured abdominal aortic aneurysm in the Amsterdam Acute Aneurysm Trial"],"prefix":"10.1093","volume":"101","author":[{"given":"M R","family":"Kapma","sequence":"first","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L M","family":"Dijksman","sequence":"additional","affiliation":[{"name":"Teaching Hospital, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J J","family":"Reimerink","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A J","family":"de Groof","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C J","family":"Zeebregts","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W","family":"Wisselink","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Balm","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M G W","family":"Dijkgraaf","sequence":"additional","affiliation":[{"name":"Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A C","family":"Vahl","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2014,1,27]]},"reference":[{"key":"2021031617595567500_bjs9356-bib-0001","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1053\/ejvs.1998.0708","article-title":"Mortality in ruptured abdominal aortic aneurysms. 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