Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms

Background. Uncertainty surrounds the best approach to management of patients with symptomless abdominal aortic aneurysms of 4.0-5.5 cm in diameter. The UK Small Aneurysm Trial showed that surveillance and early prophylactic elective surgical repair had similar survival benefits. We compared the impact on health service costs and quality of life of these two management strategies. Methods. We measured and valued direct health service costs for use of National Health Service resources. We used the Medical Outcomes Study short-form patients' health survey to measure health-related quality of life in several areas of functional status and well-being. We did analyses by intention to treat for all 1090 patients in the 93 trial centres. Findings. The mean cost of treatment in the early-surgery group was significantly higher than that for ultrasonographic surveillance (UK£4978 vs 3914, difference £1064 [95% CI 799-1328]). This finding was robust for a range of assumptions that varied the time between surveillance visits and the mean unit cost of elective aneurysm repair. Health-related quality of life was generally similar 12 months after randomisation for the two groups, but early-surgery patients reported positive improvement in current health perceptions and less negative change in bodily pain. Interpretation. Cost was higher for early surgery than for ultrasonographic surveillance for small aortic aneurysms. Early surgery is, however, associated with improvement in some features of health-related quality of life that should be taken into account with the finding that early surgical repair gives no significant survival advantage over surveillance.