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Outcomes of F and Bevar versus open surgery
Clinical implication of cost efficiency analysis
JP Becquemin on behalf of
Windows investigators Henri Mondor Hospital, University
Paris XII France
Comparison of F- B evar vs open surgery
Financed by the Ministry of Health
Windows Trial
F and Bevar
• High risk patients • Anatomically suitable for f or b evar • Treated in Selected Academic Centers
Open Surgery
• All patients recorded in the mandatory
National the Coding Data Base
End points and Analysis
• 30 D Mortality
• 30 D Severe complications
• 30 D Total Cost
• Three groups according to proximal extent
Group 1
F and Bevar = 184
pts Open Surgery = 1382
pts
Group 2
F and Bevar = 42 pts
Open surgery = 225 pts
Group 3
F and Bevar = 42 pts
Open Surgery = 71 pts
Risk factors
Risk factors F and Bevar
(n=268) Open
(n=1678) p
HTA 81,3% 51,1% <0,0001 Dyslipidemia 63,8% 34,5% <0,0001 Diabete 18,7% 12,5% 0,006 Coronaropathy 43,3% 8,2% <0,0001 Stroke 14,2% 2,1% <0,0001 PAOD 21,3% 14,5% 0,004 Heart failure 13,4% 3,2% <0,0001 Arythmia 19,4% 8,3% <0,0001 Respiratory Insufficiency 34,7% 14,4% <0,0001 Chronic Renal Insuffisiency 32,1% 6,2% <0,0001
0
5
10
15
20
25
Group 1 Group 2 Group 3
F and Bevar Open
4.5% 5 %
Group 1 : Mortality
Group 1 : Complications
Fand B evar (n=184)
Open (n=1382)
p
Amputation 0 (0,0%) 4 (0,3%) 0,46
Myocardial Infarctus 3 (1,6%) 16 (1,2%) 0,58 Stroke 3 (1,6%) 8 (0,6%) 0,11 SCI 2 (1,1%) 6 (0,4%) 0,24
Lung support ≥ 7 D 6 (3,3%) 79 (5,7%) 0,17
Bowel infarct 2 (1,1%) 38 (2,7%) 0,18
Renal Insufficiency 8 (4,3%) 251 (18,2%) <0,0001
Réintervention 22 (11,9%) 124 (9,0%) 0,19
Group 1 Cost calculation
F and Bevar Open surgery
p Mean (±ET) p Mean (±ET) p
Groupe 1 34 425 (±22 021)
<0,0001
14 907 (±12 889)
<0,0001
<0,0001
Groupe 2 37 927 (±11 994) 17 530 (±12 953) <0,0001
Groupe 3 54 710 (±28 919) 45 090 (±45 090) 0,1771
0
5
10
15
20
25
Group 1 Group 2 Group 3
F and Bevar Open
4 %
Group 2 : Mortality
12 %
P = .05
Complications – Group 2
F and B evar (n=42)
Open (n=225)
p
Amputation 1 (2,4%) 0 (0,0%) 0,020
Myocardial Infarctus 1 (2,4%) 2 (0,9%) 0,40
Stroke 1 (2,4%) 2 (0,9%) 0,40
SCI 2 (4,8%) 0 (0,0%) 0,001
Lung supports≥ 7 days 5 (11,9%) 20 (8,9%) 0,54
Bowel ischemia 3 (7,1%) 7 (3,1%) 0,21
Renal insufficiency 4 (9,5%) 68 (30,2%) 0,006
Reintervention 8 (19,0%) 30 (13,3%) 0,33
Group 2: Cost calculation
F and Bevar Open surgery
p Mean (±ET) p Mean (±ET) p
Groupe 1 34 425 (±22 021)
<0,0001
14 907 (±12 889)
<0,0001
<0,0001
Groupe 2 37 927 (±11 994) 17 530 (±12 953) <0,0001
Groupe 3 54 710 (±28 919) 45 090 (±45 090) 0,1771
0
5
10
15
20
25
Group 1 Group 2 Group 3
F and Bevar Open
Group 3 : Mortality
12 %
20 %
Group 3 : Complications
F and bevar (n=42)
Open (n=71)
p
Amputation 0 (0,0%) 0 (0,0%) -
Myocardial infarct 0 (0,0%) 2 (2,8%) 0,27
Stroke 1 (2,4%) 2 (2,8%) 0,89
SCI 7 (16,7%) 10 (14,1%) 0,71
Lung support ≥ 7 days 3 (7,1%) 25 (35,2%) 0,0008
Bowel infarct 1 (2,4%) 6 (8,5%) 0,20
Renal Insufficiency 3 (7,1%) 30 (42,3%) <0,0001
Réintervention 4 (9,5%) 19 (26,8%) 0,028
Group 3 : Cost calculation
F and Bevar Open surgery
p Mean (±ET) p Mean (±ET) p
Groupe 1 34 425 (±22 021)
<0,0001
14 907 (±12 889)
<0,0001
<0,0001
Groupe 2 37 927 (±11 994) 17 530 (±12 953) <0,0001
Groupe 3 54 710 (±28 919) 45 090 (±45 090) 0,1771
Conclusion: F and Bevar
1) In high risk patients with juxtarenal AAA Fbevar is efficient but not cost effective
2) In TAA aneurysms Fbevar is efficient and cost effective
3) In supra renal AAA Fbevar is neither efficient nor cost effective
Windows : Actors • C. Scientifique : JP Becquemin, J Marzelle • CVI : S Haulon, J Marzelle, H Kobeiter • ARCs et TEC : S Idir, N Ady, D Selmane, M Gaba • Analyse Médico Economique URC Eco :
I Durand-Zaleski , MC Clement • DRC APHP: M Quintin, M Dabbech • CODEVEC: A Long, C Mounier-Vellet, C Le Hello, J
Watelet • Imagerie : J Cross, M Majewski • URC St Etienne : S Quenet, B Deygas • Saisie des données Clininfo Lyon: V Pelletier • Centres investigateurs : Lille, Créteil, Lyon, Bordeaux ,
Nantes, Marseille, St Etienne
Outcomes of F and Bevar versus open surgery
Clinical implication of cost efficiency analysis
JP Becquemin on behalf of
Windows investigators Henri Mondor Hospital, University
Paris XII France
