of time and resource (Against) Prof Pete Holt St Georges Vascular - - PowerPoint PPT Presentation
Debate: surveillance is a waste of time and resource (Against) Prof Pete Holt St Georges Vascular Institute, London Cost Effectiveness Clinical Outcomes QUALITY Patient Safety Patient Experience Key issues in post-EVAR surveillance
Prof Pete Holt St George’s Vascular Institute, London
Clinical Outcomes Patient Safety Cost Effectiveness Patient Experience QUALITY
“Surveillance remains mandatory post-EVAR CEUS would have greater cost implications than DUS… CEUS therefore cannot be recommended… DUS performs equivalently to CT with 30% cost reduction, no nephrotoxicity and no radiation”
“…a 100% probability that EVAR is a cost-effective treatment” “The increased procedural costs of open repair are NOT outweighed by greater surveillance & reintervention costs after EVAR”
Clinical Outcomes Patient Safety Cost Effectiveness Patient Experience QUALITY
CARE RATIONING AND SUPPORTING OVERT BIAS POORLY INFORMED DECISIONS,
2 4 6 8 10 12 14 10 20 30 40 50 60 70 80 90 100 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Axis Title
Mortality and rate of EVAR in the UK 2005-2018
%EVAR mortality
1 2 3 4 5 6 7 8 9 10 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Death Rate % Year
“The overall in-hospital mortality rates for open and EVAR procedures for the period between 2015 and 2017 were 3.0% and 0.6%, respectively.” EVAR 1: 4.7 v 1.7
Failure of surveillance results in higher overall mortality and emphasises the importance of routine surveillance. ACM OR 1.43, p<0.0001
ARM (OR 1.47) ACM (OR 1.81) ACM OR 1.43, p<0.0001
based on risk
81% 77% 73% 67% 96%
Attitude and Views to Risk
69%
Modality Preference
& personalised surveillance
Clinical Outcomes Patient Safety Cost Effectiveness Patient Experience QUALITY