Follow-up costs increase the cost disparity between endovascular and open abdominal aortic aneurysm repair

ObjectiveThis study compared the hospital and follow-up costs of patients who have undergone endovascular (EVAR) or open (OR) elective abdominal aortic aneurysm repair.MethodsThe records of 195 patients (EVAR, n = 55; OR, n = 140) who underwent elective aortic aneurysm repair between 1995 and 2004 were reviewed. Primary costing data were analyzed for 54 EVAR and 135 OR patients. Hospital costs were divided into preoperative, operative, and postoperative costs. Follow-up costs for EVAR patients were recorded, with a median follow-up time of 12 months.ResultsMean preoperative costs were slightly higher in the EVAR group (AU $961/US$733 vs AU $869/US$663; not significant). Operative costs were significantly higher in the EVAR group (AU $16,124/US$12,297 vs AU $6077/US$4635; P < .001); this was entirely due to the increased cost of the endograft (AU $10,181/US$7,765 for EVAR vs AU $476/US$363 for OR). Postoperative costs were significantly reduced in the EVAR group (AU $4719/US$3599 vs AU $11,491/US$8,764; P < .001). Total hospital costs were significantly greater in the EVAR group (AU $21,804/US$16,631 vs AU $18,437/US$14,063; P < .001). The increase in total hospital costs was due to a significant difference in graft costs, which was not offset by reduced postoperative costs. The average follow-up cost per year after EVAR was AU $1316/US$999. At 1 year of follow-up, EVAR remained significantly more expensive than OR (AU $23,120/US$17,640 vs AU $18,510/US$14,122; P < .001); this cost discrepancy increased with a longer follow-up.ConclusionsEVAR results in significantly greater hospital costs compared with OR, despite reduced hospital and intensive care unit stays. The inclusion of follow-up costs further increases the cost disparity between EVAR and OR. Because EVAR requires lifelong surveillance and has a high rate of reintervention, follow-up costs must be included in any cost comparison of EVAR and OR. The economic cost, as well as the efficacy, of new technologies such as EVAR must be addressed before their widespread use is advocated

Computer mediated communication in graduate distance education: a qualitative case study

The purpose of this case study was to explore and portray the computer mediated communication (CMC) experience of distance graduate students, faculty and staff in the pilot offering of the course entitled Education 6104 - Foundations of Program Evaluation (H6KJ4) at Memorial University of Newfoundland during the Fall semester of 1995. E6104 was a new graduate education course at Memorial University and for the first time in graduate distance education at Memorial University, CMC was integrated into the course through the use of electronic mail (E-mail). Participants were required to engage in on-line small group and class discussions regarding assigned readings throughout a six week period. Additionally, students were encouraged to communicate with fellow participants, faculty and staff via E-mail. Data were gathered through semi-structured interviews of all participants, an attitude survey administered via E-mail and the regular post, and through a content analysis of all course E-mail forwarded voluntarily to the researcher throughout the study by all participants. Participants included the seventeen students, the professor and two on-site coordinators (staff). All respondents but one student indicated that they enjoyed the experience and considered it successful and most worthwhile. Benefits and limitations of the application of E-mail in this environment, from the respondents' perspective, are noted, and recommendations are made concerning E6104 and future applications of E-mail in graduate distance education

Follow-up costs increase the cost disparity between endocascular and open abdomnal aortic aneurysm repair

Objective: This study compared the hospital and follow-up costs of patients who have undergone endovascular (EVAR) or open (OR) elective abdominal aortic aneurysm repair. Methods: The records of 195 patients (EVAR, n = 55; OR, n = 140) who underwent elective aortic aneurysm repair between 1995 and 2004 were reviewed. Primary costing data were analyzed for 54 EVAR and 135 OR patients. Hospital costs were divided into preoperative, operative, and postoperative costs. Follow-up costs for EVAR patients were recorded, with a median follow-up time of 12 months. Results: Mean preoperative costs were slightly higher in the EVAR group (AU $961/US$733 vs AU $869/US$663; not significant). Operative costs were significantly higher in the EVAR group (AU $16,124/US$12,297 vs AU $6077/US$4635; P < .001); this was entirely due to the increased cost of the endograft (AU $10,181/US$7,765 for EVAR vs AU $476/US$363 for OR). Postoperative costs were significantly reduced in the EVAR group (AU $4719/US$3599 vs AU $11,491/US$8,764; P < .001). Total hospital costs were significantly greater in the EVAR group (AU $21,804/US$16,631 vs AU $18,437/US$14,063; P < .001). The increase in total hospital costs was due to a significant difference in graft costs, which was not offset by reduced postoperative costs. The average follow-up cost per year after EVAR was AU $1316/US$999. At 1 year of follow-up, EVAR remained significantly more expensive than OR (AU $23,120/US$17,640 vs AU $18,510/US$14,122; P < .001); this cost discrepancy increased with a longer follow-up. Conclusions: EVAR results in significantly greater hospital costs compared with OR, despite reduced hospital and intensive care unit stays. The inclusion of follow-up costs further increases the cost disparity between EVAR and OR. Because EVAR requires lifelong surveillance and has a high rate of reintervention, follow-up costs must be included in any cost comparison of EVAR and OR. The economic cost, as well as the efficacy, of new technologies such as EVAR must be addressed before their widespread use is advocated