Eur J Vasc Endovasc Surg. 2026 Jan 9:S1078-5884(26)00038-9. doi: 10.1016/j.ejvs.2026.01.009. Online ahead of print.
ABSTRACT
OBJECTIVE: 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 EQ-5D-5L questionnaire at baseline and at one week, 1 month, 3 months, and 6 months after operation. Resource utilisation data were obtained through the Medical Consumption Questionnaire and the Productivity Cost Questionnaire.
RESULTS: A total of 294 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 6 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 6 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 6 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 ACTION-1 trial, which was terminated early owing to futility, ACT guided heparinisation did not improve patient outcomes and resulted in a lower QoL at 6 months, along with negative cost utility.
PMID:41520771 | DOI:10.1016/j.ejvs.2026.01.009