Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial

Frank A. Lederle; Kevin T. Stroupe; Tassos C. Kyriakides; Ling Ge; Julie A. Freischlag; Erika R. Ketteler; Darra D. Kingsley; John M. Marek; Richard J. Massen; Brian D. Matteson; J. David Pitcher; Mark Langsfeld; John D. Corson; James M. Goff; Karthnik Kasirajan; Christina Paap; Diane C. Robertson; Atef Salam; Ravi Veeraswamy; Ross Milner; Karthikeshwar Kasirajan; Jane Guidot; Brajesh K. Lal; Steven J. Busuttil; Michael P. Lilly; Melita Braganza; Kea Ellis; Mark A. Patterson; William D. Jordan; David Whitley; Steve Taylor; Marc Passman; Donna Kerns; Cindy Inman; Jennifer Poirier; James Ebaugh; Joseph Raffetto; David Chew; Subhash Lathi; Christopher Owens; Kathleen Hickson; Hasan H. Dosluoglu; Karen Eschberger; Melina R. Kibbe; Henry M. Baraniewski; Jon Matsumura; Michelle Endo; Anna Busman; Wendy Meadows; Mary Evans; Joseph S. Giglia; Hosam El Sayed; Amy B. Reed; Madeline Ruf; Stephanie Ross; Jessie M. Jean-Claude; Gilles Pinault; Preet Kang; Nadine White; Matthew Eiseman; Reba Jones; Carlos H. Timaran; J. Gregory Modrall; M. Burress Welborn; Jorge Lopez; Tammy Nguyen; John K Y Chacko; Kenneth Granke; Angela G. Vouyouka; Erin Olgren; Prakash Chand; Brenda Allende; Michael Ranella; Claudia Yales; Thomas A. Whitehill; William C. Krupski; Mark R. Nehler; Stephen P. Johnson; Darrell N. Jones; Pamela Strecker; Michelle A. Bhola; Cynthia K. Shortell; John L. Gray; Jeffrey H. Lawson; Richard McCann; Mark W. Sebastian; Jean Kistler Tetterton; Carla Blackwell; Patricia A. Prinzo; Nina Lee; Frank T. Padberg; Joaquim J. Cerveira; Robert W. Zickler; Karen A. Hauck; Scott A. Berceli; W. Anthony Lee; C. Keith Ozaki; Peter R. Nelson; Anne S. Irwin; Randy Baum; Bernadette Aulivola; Heron Rodriguez; Fred N. Littooy; Howard Greisler; Mary T. O'Sullivan; Panagiotis Kougias; Peter H. Lin; Ruth L. Bush; Gene Guinn; Carlos Bechara; Catherine Cagiannos; George Pisimisis; Neal Barshes; Sherilyn Pillack; Barbara Guillory; Dolores Cikrit; Stephen G. Lalka; Gary Lemmon; Ryan Nachreiner; Mitzi Rusomaroff; Elaine O'Brien; Joseph J. Cullen; Jamal Hoballah; W. John Sharp; Jeanne L. McCandless; Vickie Beach; David Minion; Thomas H. Schwarcz; Joy Kimbrough; Laura Ashe; Anna Rockich; Jill Warner-Carpenter; Mohammed Moursi; John F. Eidt; Sandra Brock; Christian Bianchi; Vicki Bishop; Ian L. Gordon; Roy Fujitani; Stephen M. Kubaska; Mina Behdad; Reza Azadegan; Christine Maagas; Kathy Zalecki; John R. Hoch; Sandra C. Carr; Charles Acher; Margaret Schwarze; Girma Tefera; Matthew Mell; Beth Dunlap; Janice Rieder; John M. Stuart; Darryl S. Weiman; Omran Abul-Khoudoud; H. Edward Garrett; Sandra M. Walsh; Karen L. Wilson; Gary R. Seabrook; Robert A. Cambria; Kellie R. Brown; Brian D. Lewis; Susan Framberg; Christa Kallio; Roderick A. Barke; Steven M. Santilli; Alexandre C. D'Audiffret; Nancy Oberle; Catherine Proebstle; Lauri Lee Johnson; Glenn R. Jacobowitz; Neal Cayne; Caron Rockman; Mark Adelman; Paul Gagne; Matthew Nalbandian; Leah J. Caropolo; Iraklis I. Pipinos; Jason Johanning; Thomas Lynch; Holly De Spiegelaere; Georgia Purviance; Wei Zhou; Ronald Dalman; Jason T. Lee; Bassem Safadi; Sheila M. Coogan; Sherry M. Wren; Doghdoo D. Bahmani; Deanna Maples; Shawna Thunen; Michael A. Golden; Marc E. Mitchell; Ronald Fairman; Sally Reinhardt; Mark A. Wilson; Edith Tzeng; Satish Muluk; Nina M. Peterson; Maria Foster; James Edwards; Gregory L. Moneta; Gregory Landry; Lloyd Taylor; Richard Yeager; Eleanor Cannady; Gerald Treiman; Stephanie Hatton-Ward; Barbara Salabsky; Nikhil Kansal; Erik Owens; Melanie Estes; Beth A. Forbes; Cinda Sobotta; Joseph H. Rapp; Linda M. Reilly; Sandra L. Perez; Kimberly Yan; Rajaabrata Sarkar; Shelley S. Dwyer; Karen Chong; Ted R. Kohler; Thomas S. Hatsukami; David G. Glickerman; Michael Sobel; Thomas S. Burdick; Kimberly Pedersen; Patricia Cleary; Martin Back; Dennis Bandyk; Brad Johnson; Murray Shames; Rebecca L. Reinhard; Sandra C. Thomas; Glenn C. Hunter; Luis R. Leon; Alex Westerband; Robert J. Guerra; Macario Riveros; John L. Mills; John D. Hughes; Andrea M. Escalante; Shemuel B. Psalms; Nancy N. Day; Robyn Macsata; Anton Sidawy; Jonathan Weiswasser; Subodh Arora; Brenda J. Jasper; Alan Dardik; Vivian Gahtan; Bart E. Muhs; Bauer E. Sumpio; Richard J. Gusberg; Marcelo Spector; Jeffrey Pollak; John Aruny; E. Lynne Kelly; James Wong; Penny Vasilas; Carmelene Joncas; Hugh A. Gelabert; Christian De Virgillio; David A. Rigberg; Loretta Cole; Elizabeth Latts; Kathleen M. Swanson; Gary R. Johnson; Peter Guarino; Peter Peduzzi; Margaret Antonelli; Cindy Cushing; Elizabeth Davis; Lynn Durant; Shirley Joyner; Alice Kossack; Mary Le Gwin; Vanessa McBride; Terry O'Connor; June Poulton; Susan Stratton; Scott Zellner; Amanda J. Snodgrass; Julie Thornton; Clair M. Haakenson; Yvonne Jonk; John W. Hallett; Norman Hertzer; Jonathan Towne; David A. Katz; Theodore Karrison; John P. Matts; Richard Marottoli; Stanislav Kasl; Rajni Mehta; Richard Feldman; William Farrell; Heather Allore; Edward Perry; James Niederman; Sister Frances Randall; Reverend Michael Zeman; Donald Beckwith; Timothy J. O'Leary; Grant D. Huang; Marilyn Bader

doi:10.1001/jamasurg.2016.2783

Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial

Frank A. Lederle^*, Kevin T. Stroupe, Tassos C. Kyriakides, Ling Ge, Julie A. Freischlag, Erika R. Ketteler, Darra D. Kingsley, John M. Marek, Richard J. Massen, Brian D. Matteson, J. David Pitcher, Mark Langsfeld, John D. Corson, James M. Goff, Karthnik Kasirajan, Christina Paap, Diane C. Robertson, Atef Salam, Ravi Veeraswamy, Ross MilnerKarthikeshwar Kasirajan, Jane Guidot, Brajesh K. Lal, Steven J. Busuttil, Michael P. Lilly, Melita Braganza, Kea Ellis, Mark A. Patterson, William D. Jordan, David Whitley, Steve Taylor, Marc Passman, Donna Kerns, Cindy Inman, Jennifer Poirier, James Ebaugh, Joseph Raffetto, David Chew, Subhash Lathi, Christopher Owens, Kathleen Hickson, Hasan H. Dosluoglu, Karen Eschberger, Melina R. Kibbe, Henry M. Baraniewski, Jon Matsumura, Michelle Endo, Anna Busman, Wendy Meadows, Mary Evans, Joseph S. Giglia, Hosam El Sayed, Amy B. Reed, Madeline Ruf, Stephanie Ross, Jessie M. Jean-Claude, Gilles Pinault, Preet Kang, Nadine White, Matthew Eiseman, Reba Jones, Carlos H. Timaran, J. Gregory Modrall, M. Burress Welborn, Jorge Lopez, Tammy Nguyen, John K Y Chacko, Kenneth Granke, Angela G. Vouyouka, Erin Olgren, Prakash Chand, Brenda Allende, Michael Ranella, Claudia Yales, Thomas A. Whitehill, William C. Krupski, Mark R. Nehler, Stephen P. Johnson, Darrell N. Jones, Pamela Strecker, Michelle A. Bhola, Cynthia K. Shortell, John L. Gray, Jeffrey H. Lawson, Richard McCann, Mark W. Sebastian, Jean Kistler Tetterton, Carla Blackwell, Patricia A. Prinzo, Nina Lee, Frank T. Padberg, Joaquim J. Cerveira, Robert W. Zickler, Karen A. Hauck, Scott A. Berceli, W. Anthony Lee, C. Keith Ozaki, Peter R. Nelson, Anne S. Irwin, Randy Baum, Bernadette Aulivola, Heron Rodriguez, Fred N. Littooy, Howard Greisler, Mary T. O'Sullivan, Panagiotis Kougias, Peter H. Lin, Ruth L. Bush, Gene Guinn, Carlos Bechara, Catherine Cagiannos, George Pisimisis, Neal Barshes, Sherilyn Pillack, Barbara Guillory, Dolores Cikrit, Stephen G. Lalka, Gary Lemmon, Ryan Nachreiner, Mitzi Rusomaroff, Elaine O'Brien, Joseph J. Cullen, Jamal Hoballah, W. John Sharp, Jeanne L. McCandless, Vickie Beach, David Minion, Thomas H. Schwarcz, Joy Kimbrough, Laura Ashe, Anna Rockich, Jill Warner-Carpenter, Mohammed Moursi, John F. Eidt, Sandra Brock, Christian Bianchi, Vicki Bishop, Ian L. Gordon, Roy Fujitani, Stephen M. Kubaska, Mina Behdad, Reza Azadegan, Christine Maagas, Kathy Zalecki, John R. Hoch, Sandra C. Carr, Charles Acher, Margaret Schwarze, Girma Tefera, Matthew Mell, Beth Dunlap, Janice Rieder, John M. Stuart, Darryl S. Weiman, Omran Abul-Khoudoud, H. Edward Garrett, Sandra M. Walsh, Karen L. Wilson, Gary R. Seabrook, Robert A. Cambria, Kellie R. Brown, Brian D. Lewis, Susan Framberg, Christa Kallio, Roderick A. Barke, Steven M. Santilli, Alexandre C. D'Audiffret, Nancy Oberle, Catherine Proebstle, Lauri Lee Johnson, Glenn R. Jacobowitz, Neal Cayne, Caron Rockman, Mark Adelman, Paul Gagne, Matthew Nalbandian, Leah J. Caropolo, Iraklis I. Pipinos, Jason Johanning, Thomas Lynch, Holly De Spiegelaere, Georgia Purviance, Wei Zhou, Ronald Dalman, Jason T. Lee, Bassem Safadi, Sheila M. Coogan, Sherry M. Wren, Doghdoo D. Bahmani, Deanna Maples, Shawna Thunen, Michael A. Golden, Marc E. Mitchell, Ronald Fairman, Sally Reinhardt, Mark A. Wilson, Edith Tzeng, Satish Muluk, Nina M. Peterson, Maria Foster, James Edwards, Gregory L. Moneta, Gregory Landry, Lloyd Taylor, Richard Yeager, Eleanor Cannady, Gerald Treiman, Stephanie Hatton-Ward, Barbara Salabsky, Nikhil Kansal, Erik Owens, Melanie Estes, Beth A. Forbes, Cinda Sobotta, Joseph H. Rapp, Linda M. Reilly, Sandra L. Perez, Kimberly Yan, Rajaabrata Sarkar, Shelley S. Dwyer, Karen Chong, Ted R. Kohler, Thomas S. Hatsukami, David G. Glickerman, Michael Sobel, Thomas S. Burdick, Kimberly Pedersen, Patricia Cleary, Martin Back, Dennis Bandyk, Brad Johnson, Murray Shames, Rebecca L. Reinhard, Sandra C. Thomas, Glenn C. Hunter, Luis R. Leon, Alex Westerband, Robert J. Guerra, Macario Riveros, John L. Mills, John D. Hughes, Andrea M. Escalante, Shemuel B. Psalms, Nancy N. Day, Robyn Macsata, Anton Sidawy, Jonathan Weiswasser, Subodh Arora, Brenda J. Jasper, Alan Dardik, Vivian Gahtan, Bart E. Muhs, Bauer E. Sumpio, Richard J. Gusberg, Marcelo Spector, Jeffrey Pollak, John Aruny, E. Lynne Kelly, James Wong, Penny Vasilas, Carmelene Joncas, Hugh A. Gelabert, Christian De Virgillio, David A. Rigberg, Loretta Cole, Elizabeth Latts, Kathleen M. Swanson, Gary R. Johnson, Peter Guarino, Peter Peduzzi, Margaret Antonelli, Cindy Cushing, Elizabeth Davis, Lynn Durant, Shirley Joyner, Alice Kossack, Mary Le Gwin, Vanessa McBride, Terry O'Connor, June Poulton, Susan Stratton, Scott Zellner, Amanda J. Snodgrass, Julie Thornton, Clair M. Haakenson, Yvonne Jonk, John W. Hallett, Norman Hertzer, Jonathan Towne, David A. Katz, Theodore Karrison, John P. Matts, Richard Marottoli, Stanislav Kasl, Rajni Mehta, Richard Feldman, William Farrell, Heather Allore, Edward Perry, James Niederman, Sister Frances Randall, Reverend Michael Zeman, Donald Beckwith, Timothy J. O'Leary, Grant D. Huang, Marilyn Bader

^*Corresponding author for this work

Surgery, Vascular Surgery Division

Research output: Contribution to journal › Article › peer-review

29 Scopus citations

Abstract

IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

Original language	English (US)
Pages (from-to)	1139-1144
Number of pages	6
Journal	JAMA surgery
Volume	151
Issue number	12
DOIs	https://doi.org/10.1001/jamasurg.2016.2783
State	Published - Dec 1 2016

ASJC Scopus subject areas

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1001/jamasurg.2016.2783

Cite this

Lederle, F. A., Stroupe, K. T., Kyriakides, T. C., Ge, L., Freischlag, J. A., Ketteler, E. R., Kingsley, D. D., Marek, J. M., Massen, R. J., Matteson, B. D., David Pitcher, J., Langsfeld, M., Corson, J. D., Goff, J. M., Kasirajan, K., Paap, C., Robertson, D. C., Salam, A., Veeraswamy, R., ... Bader, M. (2016). Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial. JAMA surgery, 151(12), 1139-1144. https://doi.org/10.1001/jamasurg.2016.2783

@article{dca04be6cc31486582b92be726e5b6f5,

title = "Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial",

abstract = "IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.",

author = "Lederle, {Frank A.} and Stroupe, {Kevin T.} and Kyriakides, {Tassos C.} and Ling Ge and Freischlag, {Julie A.} and Ketteler, {Erika R.} and Kingsley, {Darra D.} and Marek, {John M.} and Massen, {Richard J.} and Matteson, {Brian D.} and {David Pitcher}, J. and Mark Langsfeld and Corson, {John D.} and Goff, {James M.} and Karthnik Kasirajan and Christina Paap and Robertson, {Diane C.} and Atef Salam and Ravi Veeraswamy and Ross Milner and Karthikeshwar Kasirajan and Jane Guidot and Lal, {Brajesh K.} and Busuttil, {Steven J.} and Lilly, {Michael P.} and Melita Braganza and Kea Ellis and Patterson, {Mark A.} and Jordan, {William D.} and David Whitley and Steve Taylor and Marc Passman and Donna Kerns and Cindy Inman and Jennifer Poirier and James Ebaugh and Joseph Raffetto and David Chew and Subhash Lathi and Christopher Owens and Kathleen Hickson and Dosluoglu, {Hasan H.} and Karen Eschberger and Kibbe, {Melina R.} and Baraniewski, {Henry M.} and Jon Matsumura and Michelle Endo and Anna Busman and Wendy Meadows and Mary Evans and Giglia, {Joseph S.} and {El Sayed}, Hosam and Reed, {Amy B.} and Madeline Ruf and Stephanie Ross and Jean-Claude, {Jessie M.} and Gilles Pinault and Preet Kang and Nadine White and Matthew Eiseman and Reba Jones and Timaran, {Carlos H.} and {Gregory Modrall}, J. and {Burress Welborn}, M. and Jorge Lopez and Tammy Nguyen and Chacko, {John K Y} and Kenneth Granke and Vouyouka, {Angela G.} and Erin Olgren and Prakash Chand and Brenda Allende and Michael Ranella and Claudia Yales and Whitehill, {Thomas A.} and Krupski, {William C.} and Nehler, {Mark R.} and Johnson, {Stephen P.} and Jones, {Darrell N.} and Pamela Strecker and Bhola, {Michelle A.} and Shortell, {Cynthia K.} and Gray, {John L.} and Lawson, {Jeffrey H.} and Richard McCann and Sebastian, {Mark W.} and Tetterton, {Jean Kistler} and Carla Blackwell and Prinzo, {Patricia A.} and Nina Lee and Padberg, {Frank T.} and Cerveira, {Joaquim J.} and Zickler, {Robert W.} and Hauck, {Karen A.} and Berceli, {Scott A.} and {Anthony Lee}, W. and {Keith Ozaki}, C. and Nelson, {Peter R.} and Irwin, {Anne S.} and Randy Baum and Bernadette Aulivola and Heron Rodriguez and Littooy, {Fred N.} and Howard Greisler and O'Sullivan, {Mary T.} and Panagiotis Kougias and Lin, {Peter H.} and Bush, {Ruth L.} and Gene Guinn and Carlos Bechara and Catherine Cagiannos and George Pisimisis and Neal Barshes and Sherilyn Pillack and Barbara Guillory and Dolores Cikrit and Lalka, {Stephen G.} and Gary Lemmon and Ryan Nachreiner and Mitzi Rusomaroff and Elaine O'Brien and Cullen, {Joseph J.} and Jamal Hoballah and {John Sharp}, W. and McCandless, {Jeanne L.} and Vickie Beach and David Minion and Schwarcz, {Thomas H.} and Joy Kimbrough and Laura Ashe and Anna Rockich and Jill Warner-Carpenter and Mohammed Moursi and Eidt, {John F.} and Sandra Brock and Christian Bianchi and Vicki Bishop and Gordon, {Ian L.} and Roy Fujitani and Kubaska, {Stephen M.} and Mina Behdad and Reza Azadegan and Christine Maagas and Kathy Zalecki and Hoch, {John R.} and Carr, {Sandra C.} and Charles Acher and Margaret Schwarze and Girma Tefera and Matthew Mell and Beth Dunlap and Janice Rieder and Stuart, {John M.} and Weiman, {Darryl S.} and Omran Abul-Khoudoud and {Edward Garrett}, H. and Walsh, {Sandra M.} and Wilson, {Karen L.} and Seabrook, {Gary R.} and Cambria, {Robert A.} and Brown, {Kellie R.} and Lewis, {Brian D.} and Susan Framberg and Christa Kallio and Barke, {Roderick A.} and Santilli, {Steven M.} and D'Audiffret, {Alexandre C.} and Nancy Oberle and Catherine Proebstle and Johnson, {Lauri Lee} and Jacobowitz, {Glenn R.} and Neal Cayne and Caron Rockman and Mark Adelman and Paul Gagne and Matthew Nalbandian and Caropolo, {Leah J.} and Pipinos, {Iraklis I.} and Jason Johanning and Thomas Lynch and {De Spiegelaere}, Holly and Georgia Purviance and Wei Zhou and Ronald Dalman and Lee, {Jason T.} and Bassem Safadi and Coogan, {Sheila M.} and Wren, {Sherry M.} and Bahmani, {Doghdoo D.} and Deanna Maples and Shawna Thunen and Golden, {Michael A.} and Mitchell, {Marc E.} and Ronald Fairman and Sally Reinhardt and Wilson, {Mark A.} and Edith Tzeng and Satish Muluk and Peterson, {Nina M.} and Maria Foster and James Edwards and Moneta, {Gregory L.} and Gregory Landry and Lloyd Taylor and Richard Yeager and Eleanor Cannady and Gerald Treiman and Stephanie Hatton-Ward and Barbara Salabsky and Nikhil Kansal and Erik Owens and Melanie Estes and Forbes, {Beth A.} and Cinda Sobotta and Rapp, {Joseph H.} and Reilly, {Linda M.} and Perez, {Sandra L.} and Kimberly Yan and Rajaabrata Sarkar and Dwyer, {Shelley S.} and Karen Chong and Kohler, {Ted R.} and Hatsukami, {Thomas S.} and Glickerman, {David G.} and Michael Sobel and Burdick, {Thomas S.} and Kimberly Pedersen and Patricia Cleary and Martin Back and Dennis Bandyk and Brad Johnson and Murray Shames and Reinhard, {Rebecca L.} and Thomas, {Sandra C.} and Hunter, {Glenn C.} and Leon, {Luis R.} and Alex Westerband and Guerra, {Robert J.} and Macario Riveros and Mills, {John L.} and Hughes, {John D.} and Escalante, {Andrea M.} and Psalms, {Shemuel B.} and Day, {Nancy N.} and Robyn Macsata and Anton Sidawy and Jonathan Weiswasser and Subodh Arora and Jasper, {Brenda J.} and Alan Dardik and Vivian Gahtan and Muhs, {Bart E.} and Sumpio, {Bauer E.} and Gusberg, {Richard J.} and Marcelo Spector and Jeffrey Pollak and John Aruny and {Lynne Kelly}, E. and James Wong and Penny Vasilas and Carmelene Joncas and Gelabert, {Hugh A.} and {De Virgillio}, Christian and Rigberg, {David A.} and Loretta Cole and Elizabeth Latts and Swanson, {Kathleen M.} and Johnson, {Gary R.} and Peter Guarino and Peter Peduzzi and Margaret Antonelli and Cindy Cushing and Elizabeth Davis and Lynn Durant and Shirley Joyner and Alice Kossack and {Le Gwin}, Mary and Vanessa McBride and Terry O'Connor and June Poulton and Susan Stratton and Scott Zellner and Snodgrass, {Amanda J.} and Julie Thornton and Haakenson, {Clair M.} and Yvonne Jonk and Hallett, {John W.} and Norman Hertzer and Jonathan Towne and Katz, {David A.} and Theodore Karrison and Matts, {John P.} and Richard Marottoli and Stanislav Kasl and Rajni Mehta and Richard Feldman and William Farrell and Heather Allore and Edward Perry and James Niederman and Randall, {Sister Frances} and Zeman, {Reverend Michael} and Donald Beckwith and O'Leary, {Timothy J.} and Huang, {Grant D.} and Marilyn Bader",

year = "2016",

month = dec,

day = "1",

doi = "10.1001/jamasurg.2016.2783",

language = "English (US)",

volume = "151",

pages = "1139--1144",

journal = "JAMA surgery",

issn = "2168-6254",

publisher = "American Medical Association",

number = "12",

}

Lederle, FA, Stroupe, KT, Kyriakides, TC, Ge, L, Freischlag, JA, Ketteler, ER, Kingsley, DD, Marek, JM, Massen, RJ, Matteson, BD, David Pitcher, J, Langsfeld, M, Corson, JD, Goff, JM, Kasirajan, K, Paap, C, Robertson, DC, Salam, A, Veeraswamy, R, Milner, R, Kasirajan, K, Guidot, J, Lal, BK, Busuttil, SJ, Lilly, MP, Braganza, M, Ellis, K, Patterson, MA, Jordan, WD, Whitley, D, Taylor, S, Passman, M, Kerns, D, Inman, C, Poirier, J, Ebaugh, J, Raffetto, J, Chew, D, Lathi, S, Owens, C, Hickson, K, Dosluoglu, HH, Eschberger, K, Kibbe, MR, Baraniewski, HM, Matsumura, J, Endo, M, Busman, A, Meadows, W, Evans, M, Giglia, JS, El Sayed, H, Reed, AB, Ruf, M, Ross, S, Jean-Claude, JM, Pinault, G, Kang, P, White, N, Eiseman, M, Jones, R, Timaran, CH, Gregory Modrall, J, Burress Welborn, M, Lopez, J, Nguyen, T, Chacko, JKY, Granke, K, Vouyouka, AG, Olgren, E, Chand, P, Allende, B, Ranella, M, Yales, C, Whitehill, TA, Krupski, WC, Nehler, MR, Johnson, SP, Jones, DN, Strecker, P, Bhola, MA, Shortell, CK, Gray, JL, Lawson, JH, McCann, R, Sebastian, MW, Tetterton, JK, Blackwell, C, Prinzo, PA, Lee, N, Padberg, FT, Cerveira, JJ, Zickler, RW, Hauck, KA, Berceli, SA, Anthony Lee, W, Keith Ozaki, C, Nelson, PR, Irwin, AS, Baum, R, Aulivola, B, Rodriguez, H, Littooy, FN, Greisler, H, O'Sullivan, MT, Kougias, P, Lin, PH, Bush, RL, Guinn, G, Bechara, C, Cagiannos, C, Pisimisis, G, Barshes, N, Pillack, S, Guillory, B, Cikrit, D, Lalka, SG, Lemmon, G, Nachreiner, R, Rusomaroff, M, O'Brien, E, Cullen, JJ, Hoballah, J, John Sharp, W, McCandless, JL, Beach, V, Minion, D, Schwarcz, TH, Kimbrough, J, Ashe, L, Rockich, A, Warner-Carpenter, J, Moursi, M, Eidt, JF, Brock, S, Bianchi, C, Bishop, V, Gordon, IL, Fujitani, R, Kubaska, SM, Behdad, M, Azadegan, R, Maagas, C, Zalecki, K, Hoch, JR, Carr, SC, Acher, C, Schwarze, M, Tefera, G, Mell, M, Dunlap, B, Rieder, J, Stuart, JM, Weiman, DS, Abul-Khoudoud, O, Edward Garrett, H, Walsh, SM, Wilson, KL, Seabrook, GR, Cambria, RA, Brown, KR, Lewis, BD, Framberg, S, Kallio, C, Barke, RA, Santilli, SM, D'Audiffret, AC, Oberle, N, Proebstle, C, Johnson, LL, Jacobowitz, GR, Cayne, N, Rockman, C, Adelman, M, Gagne, P, Nalbandian, M, Caropolo, LJ, Pipinos, II, Johanning, J, Lynch, T, De Spiegelaere, H, Purviance, G, Zhou, W, Dalman, R, Lee, JT, Safadi, B, Coogan, SM, Wren, SM, Bahmani, DD, Maples, D, Thunen, S, Golden, MA, Mitchell, ME, Fairman, R, Reinhardt, S, Wilson, MA, Tzeng, E, Muluk, S, Peterson, NM, Foster, M, Edwards, J, Moneta, GL, Landry, G, Taylor, L, Yeager, R, Cannady, E, Treiman, G, Hatton-Ward, S, Salabsky, B, Kansal, N, Owens, E, Estes, M, Forbes, BA, Sobotta, C, Rapp, JH, Reilly, LM, Perez, SL, Yan, K, Sarkar, R, Dwyer, SS, Chong, K, Kohler, TR, Hatsukami, TS, Glickerman, DG, Sobel, M, Burdick, TS, Pedersen, K, Cleary, P, Back, M, Bandyk, D, Johnson, B, Shames, M, Reinhard, RL, Thomas, SC, Hunter, GC, Leon, LR, Westerband, A, Guerra, RJ, Riveros, M, Mills, JL, Hughes, JD, Escalante, AM, Psalms, SB, Day, NN, Macsata, R, Sidawy, A, Weiswasser, J, Arora, S, Jasper, BJ, Dardik, A, Gahtan, V, Muhs, BE, Sumpio, BE, Gusberg, RJ, Spector, M, Pollak, J, Aruny, J, Lynne Kelly, E, Wong, J, Vasilas, P, Joncas, C, Gelabert, HA, De Virgillio, C, Rigberg, DA, Cole, L, Latts, E, Swanson, KM, Johnson, GR, Guarino, P, Peduzzi, P, Antonelli, M, Cushing, C, Davis, E, Durant, L, Joyner, S, Kossack, A, Le Gwin, M, McBride, V, O'Connor, T, Poulton, J, Stratton, S, Zellner, S, Snodgrass, AJ, Thornton, J, Haakenson, CM, Jonk, Y, Hallett, JW, Hertzer, N, Towne, J, Katz, DA, Karrison, T, Matts, JP, Marottoli, R, Kasl, S, Mehta, R, Feldman, R, Farrell, W, Allore, H, Perry, E, Niederman, J, Randall, SF, Zeman, RM, Beckwith, D, O'Leary, TJ, Huang, GD & Bader, M 2016, 'Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial', JAMA surgery, vol. 151, no. 12, pp. 1139-1144. https://doi.org/10.1001/jamasurg.2016.2783

TY - JOUR

T1 - Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm

T2 - A randomized clinical trial

AU - Lederle, Frank A.

AU - Stroupe, Kevin T.

AU - Kyriakides, Tassos C.

AU - Ge, Ling

AU - Freischlag, Julie A.

AU - Ketteler, Erika R.

AU - Kingsley, Darra D.

AU - Marek, John M.

AU - Massen, Richard J.

AU - Matteson, Brian D.

AU - David Pitcher, J.

AU - Langsfeld, Mark

AU - Corson, John D.

AU - Goff, James M.

AU - Kasirajan, Karthnik

AU - Paap, Christina

AU - Robertson, Diane C.

AU - Salam, Atef

AU - Veeraswamy, Ravi

AU - Milner, Ross

AU - Kasirajan, Karthikeshwar

AU - Guidot, Jane

AU - Lal, Brajesh K.

AU - Busuttil, Steven J.

AU - Lilly, Michael P.

AU - Braganza, Melita

AU - Ellis, Kea

AU - Patterson, Mark A.

AU - Jordan, William D.

AU - Whitley, David

AU - Taylor, Steve

AU - Passman, Marc

AU - Kerns, Donna

AU - Inman, Cindy

AU - Poirier, Jennifer

AU - Ebaugh, James

AU - Raffetto, Joseph

AU - Chew, David

AU - Lathi, Subhash

AU - Owens, Christopher

AU - Hickson, Kathleen

AU - Dosluoglu, Hasan H.

AU - Eschberger, Karen

AU - Kibbe, Melina R.

AU - Baraniewski, Henry M.

AU - Matsumura, Jon

AU - Endo, Michelle

AU - Busman, Anna

AU - Meadows, Wendy

AU - Evans, Mary

AU - Giglia, Joseph S.

AU - El Sayed, Hosam

AU - Reed, Amy B.

AU - Ruf, Madeline

AU - Ross, Stephanie

AU - Jean-Claude, Jessie M.

AU - Pinault, Gilles

AU - Kang, Preet

AU - White, Nadine

AU - Eiseman, Matthew

AU - Jones, Reba

AU - Timaran, Carlos H.

AU - Gregory Modrall, J.

AU - Burress Welborn, M.

AU - Lopez, Jorge

AU - Nguyen, Tammy

AU - Chacko, John K Y

AU - Granke, Kenneth

AU - Vouyouka, Angela G.

AU - Olgren, Erin

AU - Chand, Prakash

AU - Allende, Brenda

AU - Ranella, Michael

AU - Yales, Claudia

AU - Whitehill, Thomas A.

AU - Krupski, William C.

AU - Nehler, Mark R.

AU - Johnson, Stephen P.

AU - Jones, Darrell N.

AU - Strecker, Pamela

AU - Bhola, Michelle A.

AU - Shortell, Cynthia K.

AU - Gray, John L.

AU - Lawson, Jeffrey H.

AU - McCann, Richard

AU - Sebastian, Mark W.

AU - Tetterton, Jean Kistler

AU - Blackwell, Carla

AU - Prinzo, Patricia A.

AU - Lee, Nina

AU - Padberg, Frank T.

AU - Cerveira, Joaquim J.

AU - Zickler, Robert W.

AU - Hauck, Karen A.

AU - Berceli, Scott A.

AU - Anthony Lee, W.

AU - Keith Ozaki, C.

AU - Nelson, Peter R.

AU - Irwin, Anne S.

AU - Baum, Randy

AU - Aulivola, Bernadette

AU - Rodriguez, Heron

AU - Littooy, Fred N.

AU - Greisler, Howard

AU - O'Sullivan, Mary T.

AU - Kougias, Panagiotis

AU - Lin, Peter H.

AU - Bush, Ruth L.

AU - Guinn, Gene

AU - Bechara, Carlos

AU - Cagiannos, Catherine

AU - Pisimisis, George

AU - Barshes, Neal

AU - Pillack, Sherilyn

AU - Guillory, Barbara

AU - Cikrit, Dolores

AU - Lalka, Stephen G.

AU - Lemmon, Gary

AU - Nachreiner, Ryan

AU - Rusomaroff, Mitzi

AU - O'Brien, Elaine

AU - Cullen, Joseph J.

AU - Hoballah, Jamal

AU - John Sharp, W.

AU - McCandless, Jeanne L.

AU - Beach, Vickie

AU - Minion, David

AU - Schwarcz, Thomas H.

AU - Kimbrough, Joy

AU - Ashe, Laura

AU - Rockich, Anna

AU - Warner-Carpenter, Jill

AU - Moursi, Mohammed

AU - Eidt, John F.

AU - Brock, Sandra

AU - Bianchi, Christian

AU - Bishop, Vicki

AU - Gordon, Ian L.

AU - Fujitani, Roy

AU - Kubaska, Stephen M.

AU - Behdad, Mina

AU - Azadegan, Reza

AU - Maagas, Christine

AU - Zalecki, Kathy

AU - Hoch, John R.

AU - Carr, Sandra C.

AU - Acher, Charles

AU - Schwarze, Margaret

AU - Tefera, Girma

AU - Mell, Matthew

AU - Dunlap, Beth

AU - Rieder, Janice

AU - Stuart, John M.

AU - Weiman, Darryl S.

AU - Abul-Khoudoud, Omran

AU - Edward Garrett, H.

AU - Walsh, Sandra M.

AU - Wilson, Karen L.

AU - Seabrook, Gary R.

AU - Cambria, Robert A.

AU - Brown, Kellie R.

AU - Lewis, Brian D.

AU - Framberg, Susan

AU - Kallio, Christa

AU - Barke, Roderick A.

AU - Santilli, Steven M.

AU - D'Audiffret, Alexandre C.

AU - Oberle, Nancy

AU - Proebstle, Catherine

AU - Johnson, Lauri Lee

AU - Jacobowitz, Glenn R.

AU - Cayne, Neal

AU - Rockman, Caron

AU - Adelman, Mark

AU - Gagne, Paul

AU - Nalbandian, Matthew

AU - Caropolo, Leah J.

AU - Pipinos, Iraklis I.

AU - Johanning, Jason

AU - Lynch, Thomas

AU - De Spiegelaere, Holly

AU - Purviance, Georgia

AU - Zhou, Wei

AU - Dalman, Ronald

AU - Lee, Jason T.

AU - Safadi, Bassem

AU - Coogan, Sheila M.

AU - Wren, Sherry M.

AU - Bahmani, Doghdoo D.

AU - Maples, Deanna

AU - Thunen, Shawna

AU - Golden, Michael A.

AU - Mitchell, Marc E.

AU - Fairman, Ronald

AU - Reinhardt, Sally

AU - Wilson, Mark A.

AU - Tzeng, Edith

AU - Muluk, Satish

AU - Peterson, Nina M.

AU - Foster, Maria

AU - Edwards, James

AU - Moneta, Gregory L.

AU - Landry, Gregory

AU - Taylor, Lloyd

AU - Yeager, Richard

AU - Cannady, Eleanor

AU - Treiman, Gerald

AU - Hatton-Ward, Stephanie

AU - Salabsky, Barbara

AU - Kansal, Nikhil

AU - Owens, Erik

AU - Estes, Melanie

AU - Forbes, Beth A.

AU - Sobotta, Cinda

AU - Rapp, Joseph H.

AU - Reilly, Linda M.

AU - Perez, Sandra L.

AU - Yan, Kimberly

AU - Sarkar, Rajaabrata

AU - Dwyer, Shelley S.

AU - Chong, Karen

AU - Kohler, Ted R.

AU - Hatsukami, Thomas S.

AU - Glickerman, David G.

AU - Sobel, Michael

AU - Burdick, Thomas S.

AU - Pedersen, Kimberly

AU - Cleary, Patricia

AU - Back, Martin

AU - Bandyk, Dennis

AU - Johnson, Brad

AU - Shames, Murray

AU - Reinhard, Rebecca L.

AU - Thomas, Sandra C.

AU - Hunter, Glenn C.

AU - Leon, Luis R.

AU - Westerband, Alex

AU - Guerra, Robert J.

AU - Riveros, Macario

AU - Mills, John L.

AU - Hughes, John D.

AU - Escalante, Andrea M.

AU - Psalms, Shemuel B.

AU - Day, Nancy N.

AU - Macsata, Robyn

AU - Sidawy, Anton

AU - Weiswasser, Jonathan

AU - Arora, Subodh

AU - Jasper, Brenda J.

AU - Dardik, Alan

AU - Gahtan, Vivian

AU - Muhs, Bart E.

AU - Sumpio, Bauer E.

AU - Gusberg, Richard J.

AU - Spector, Marcelo

AU - Pollak, Jeffrey

AU - Aruny, John

AU - Lynne Kelly, E.

AU - Wong, James

AU - Vasilas, Penny

AU - Joncas, Carmelene

AU - Gelabert, Hugh A.

AU - De Virgillio, Christian

AU - Rigberg, David A.

AU - Cole, Loretta

AU - Latts, Elizabeth

AU - Swanson, Kathleen M.

AU - Johnson, Gary R.

AU - Guarino, Peter

AU - Peduzzi, Peter

AU - Antonelli, Margaret

AU - Cushing, Cindy

AU - Davis, Elizabeth

AU - Durant, Lynn

AU - Joyner, Shirley

AU - Kossack, Alice

AU - Le Gwin, Mary

AU - McBride, Vanessa

AU - O'Connor, Terry

AU - Poulton, June

AU - Stratton, Susan

AU - Zellner, Scott

AU - Snodgrass, Amanda J.

AU - Thornton, Julie

AU - Haakenson, Clair M.

AU - Jonk, Yvonne

AU - Hallett, John W.

AU - Hertzer, Norman

AU - Towne, Jonathan

AU - Katz, David A.

AU - Karrison, Theodore

AU - Matts, John P.

AU - Marottoli, Richard

AU - Kasl, Stanislav

AU - Mehta, Rajni

AU - Feldman, Richard

AU - Farrell, William

AU - Allore, Heather

AU - Perry, Edward

AU - Niederman, James

AU - Randall, Sister Frances

AU - Zeman, Reverend Michael

AU - Beckwith, Donald

AU - O'Leary, Timothy J.

AU - Huang, Grant D.

AU - Bader, Marilyn

PY - 2016/12/1

Y1 - 2016/12/1

N2 - IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

AB - IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, -$10 788; 95% CI, -$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to $7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.

UR - http://www.scopus.com/inward/record.url?scp=85011408066&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011408066&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2016.2783

DO - 10.1001/jamasurg.2016.2783

M3 - Article

C2 - 27627802

AN - SCOPUS:85011408066

SN - 2168-6254

VL - 151

SP - 1139

EP - 1144

JO - JAMA surgery

JF - JAMA surgery

IS - 12

ER -

Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial

Abstract

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this