Quality of Life, Cost Effectiveness, and Cost Utility Analysis of Activated Clotting Time Guided Heparinisation vs. a Single Bolus of Heparin in Open Abdominal Aortic Aneurysm Repair

OBJECTIVE: To conduct a health and economic evaluation of different heparinisation strategies during elective open abdominal aortic aneurysm repair. METHODS: Costs were derived from the Dutch National Health Institute, the Dutch Pharmacotherapeutic Registry, and the local hospital ledger. Quality of life (QoL) was assessed using the EuroQol-5-dimension-5-level questionnaire at baseline and at one week, and one, three, and six months after the operation. Resource utilisation data were obtained through the Medical Consumption Questionnaire and the Productivity Cost Questionnaire. RESULTS: Two hundred and ninety-four patients were included; of these, 149 received activated clotting time (ACT) guided heparinisation and 145 received a single bolus of 5 000 IU of heparin. Total healthcare costs at six months were €3 035 313 for the ACT guided group (n = 149) compared with €2 627 682 for the control group (n = 145). The mean total costs per patient were €20 371 (95% confidence interval [CI] 17 090 - 23 653) in the ACT guided group and €18 122 (95% CI 14 849 - 21 395) in the control group (mean difference per patient €2 249, 95% CI -2 370 - 6 868, p = .34). Mean quality adjusted life years over six months was 0.365 (95% CI 0.345 - 0.385) in the ACT group and 0.395 (95% CI 0.375 - 0.415) in the control group (difference 0.030, 95% CI 0.002 - 0.059). QoL at six months was lower in the ACT group (p = .037). Incremental cost utility and cost effectiveness ratios were -€74 664 (95% bias corrected and accelerated CI -444 389 - 195 579) and €83 354 (95% bias corrected and accelerated CI -471 353 - 651 004), respectively. CONCLUSION: In the Activated Clotting Time Guided Heparinisation during Open Abdominal Aortic Aneurysm Repair trial, which was terminated early owing to futility, ACT guided heparinisation did not improve patient outcomes and resulted in a lower QoL at six months, along with negative cost utility.