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Abdominal Aortic An...
Abdominal Aortic Aneurysm : Epidemiological and Health Economic Aspects
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- Mani, Kevin, 1975- (författare)
- Uppsala universitet,Kärlkirurgi
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- Wanhainen, Anders, Associate professor (preses)
- Uppsala universitet,Kärlkirurgi
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- Björck, Martin, Professor (preses)
- Uppsala universitet,Kärlkirurgi
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- Lundkvist, Jonas, Associate professor (preses)
- Medical management centre, Karolinska Institutet
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- Kent, Craig, Professor (opponent)
- University of Wisconsin - Madison, Department of Surgery, Section of Vascular Surgery
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(creator_code:org_t)
- ISBN 9789155476700
- Uppsala : Acta Universitatis Upsaliensis, 2010
- Engelska 86 s.
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Serie: Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206 ; 503
- Relaterad länk:
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https://uu.diva-port... (primary) (Raw object)
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- Abdominal aortic aneurysm (AAA) is a common disease that is life threatening when rupture occurs. The aims of this thesis were to study (I) the long-term survival after AAA repair, (II) the cost of repair with open (OR) and endovascular (EVAR) technique, (III) the effect of different statistical methods on interpretation of cost data, (IV) the prevalence of the disease among patients with suspected arterial disease referred to the vascular laboratory, and (V) the cost-effectiveness of selective high-risk screening. Analyses of data from the Swedish vascular registry (Swedvasc), local patient registries, patient records and hospital cost registries form the basis of this thesis. Short- and long-term survival after intact AAA repair improved over the past two decades, despite increasing patient age and rate of comorbidities over time. Compared to a general population adjusted for age, sex and calendar year, the relative 5-year survival was 90% among those surviving repair. While short-term survival improved over time after ruptured repair, relative long-term survival was stable. Despite differences in patient selection and cost structure, the total cost of AAA repair with EVAR and OR was similar in a population based setting (€28,193). There was lack of consistency in the methods used in cost-analysis in the current literature, and p-values were highly dependent on test method. The practice of selective (non-population-based) screening for AAA among patients referred to the vascular laboratory was studied. The prevalence of AAA was 4.2% among male and 1.5% among female patients. AAA was associated with high age and prevalence of arterial stenosis. Of AAAs detected through selective screening, 21.5% had undergone elective repair at 7.5 years follow-up. In a health-economic evaluation, the incremental cost-effectiveness ratio of selective screening was €11,084 per life year gained. In conclusion, survival after intact AAA repair has improved over time, despite changes in case-mix. Results of health economic reports on cost of AAA repair can be highly dependent on patient selection as well as presentation of data and the statistical methods used. Selective screening for AAA among patients referred to the vascular laboratory is cost-effective.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- Abdominal aortic aneurysm
- cost
- cost-effectiveness
- endovascular aneurysm repair
- screening
- surgery
- survival
- Vascular surgery
- Kärlkirurgi
- Kirurgi
- Surgery
Publikations- och innehållstyp
- vet (ämneskategori)
- dok (ämneskategori)
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