Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms  Wouter Hogendoorn, MD, PhD, Anthi Lavida,

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Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms  Wouter Hogendoorn, MD, PhD, Anthi Lavida, MBBS, M.G. Myriam Hunink, MD, PhD, Frans L. Moll, MD, PhD, George Geroulakos, MD, PhD, Bart E. Muhs, MD, PhD, Bauer E. Sumpio, MD, PhD  Journal of Vascular Surgery  Volume 61, Issue 6, Pages 1432-1440 (June 2015) DOI: 10.1016/j.jvs.2014.12.064 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 Simplified bubble diagram shows the Markov state transition model for treatment of splenic artery aneurysms (SAA). CONS, Conservative management. Journal of Vascular Surgery 2015 61, 1432-1440DOI: (10.1016/j.jvs.2014.12.064) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 The 95% confidence ellipses are shown for the cost-effectiveness in quality-adjusted life years (QALYs) of (A) endovascular repair (EV) vs open repair (OPEN), (B) EV vs conservative management (CONS) and (C) OPEN vs CONS for 10,000 samples of the reference-case patients, which were 55-year-old women with splenic artery aneurysms (SAAs). For each of the 10,000 samples, the difference between the QALYs (incremental QALYs) and the difference between the costs (incremental costs) for EV and OR were calculated and are depicted as a dot. The circle depicts 95% of the distribution. The willingness to pay (WTP) of $60,000/QALY is indicated. All dots southeast of the WTP line are considered cost-effective. Journal of Vascular Surgery 2015 61, 1432-1440DOI: (10.1016/j.jvs.2014.12.064) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 An acceptability curve of different treatment strategies for splenic artery aneurysms (SAAs) shows that that the higher the willingness to pay (WTP), the higher the proportion of samples for which endovascular repair (EV) is cost-effective. Decreasing the WTP will lead to a higher chance that conservative management (CONS) is the most cost-effective treatment. OPEN, open repair. Journal of Vascular Surgery 2015 61, 1432-1440DOI: (10.1016/j.jvs.2014.12.064) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 Most cost-effective treatment of splenic artery aneurysms (SAAs) is shown based on current data in the literature and on age, sex, and risk profile of the patient. CONS, conservative management; EV, endovascular repair. Journal of Vascular Surgery 2015 61, 1432-1440DOI: (10.1016/j.jvs.2014.12.064) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 5 Number of expected reinterventions depending on the age at the initial intervention for splenic artery aneurysms (SAAs) is shown for the reference-case patients (55-year-old women). CONS, Conservative management; EV, endovascular repair; OPEN, open repair. Journal of Vascular Surgery 2015 61, 1432-1440DOI: (10.1016/j.jvs.2014.12.064) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 6 Flowchart shows decision making for the treatment of splenic artery aneurysms (SAAs). CONS, Conservative management; EV, endovascular repair; OPEN, open repair. Journal of Vascular Surgery 2015 61, 1432-1440DOI: (10.1016/j.jvs.2014.12.064) Copyright © 2015 Society for Vascular Surgery Terms and Conditions