B. J. Kedwai1, J. Geiger1, D. Lehane1, K. Newhall1, G. Pitcher1, M. Stoner1, D. Mix1 1University of Rochester Medical Center, Department Of Surgery, Division Of Vascular Surgery, ROCHESTER, NY, USA
Introduction:
Physician-modified endografts have been used for endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) in the United States for two decades with good short and long-term outcomes. However, there is limited data on the financial impact of PMEGs compared with commercially available fenestrated-branched devices or traditional open surgical repair (OSR). This study aimed to compare the early financial and clinical outcomes of TAAAs treated with PMEGs to the Cook Zenith-Fenestrated (ZFEN) graft for juxtarenal aortic aneurysms (JRAAAs) and to OSR.
Methods:
A retrospective review of financial and clinical data was performed for all patients who underwent endovascular or OSR of JRAAAs and TAAAs from January 2018 – December 2022 at a single academic medical center. Clinical presentation, demographics, operative details, and outcomes were reviewed. Financial data was obtained through the institution’s Finance Department. The primary endpoint was contribution margin (CM). Secondary endpoints included net profit, and 30-day and 1-year mortality. Student’s t-test was used to calculate p-values for continuous variables. Fisher’s exact test was used to calculate p-values for all proportions.
Results:
Thirty patients underwent TAAA or JRAAA repair during the study period. Twelve patients were repaired with PMEG, seven with ZFEN, and eleven with OSR. PMEG repairs had a total CM of -$110,000 compared to $18,000 for ZFEN and $294,000 for OSR. Average CM by procedure type is shown in Figure 1. Aortic and branch artery implants were the major cost driver for endovascular procedures. The total device cost was nearly twice as much per PMEG repair versus ZFEN: $46,000 versus $25,000 (p < 0.05). Extent II TAAA repairs were the costliest PMEG procedure, with a total device cost of $59,000 per case. PMEG repairs had thirty-day and one-year mortality rates of 8.3% which was not significantly different from ZFEN (0.0%, p = 0.46; 0.0%, p = 0.46) or OSR (9.1%, p = 0.95; 18%, p = 0.51). PMEG repairs had an average ICU stay of 3.1 days and hospital stay of 5.1 days. This was comparable to ZFEN (1.1, p = 0.07; 4.9, p = 0.90) and shorter than OSR (11, p < 0.05; 20, p < 0.05).
Conclusion:
This comparison of PMEG to the Cook-ZFEN graft and OSR is one of a limited number of studies on the financial viability of PMEGs. Our study demonstrates that PMEG repairs yield a negative contribution margin. To make these cases financially viable for hospital systems, device costs will need to be reduced or reimbursement rates increased by approximately $9,000.
