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Anya C. Brox, BSc; Kristian B. Filion, BSc; Xun Zhang, MSc; Louise Pilote, MD, MPH, PhD; Daniel Obrand, MD; Seema Haider, MSc; Arik Azoulay, MSc; Mark J. Eisenberg, MD, MPH

Arch Intern Med. 2003;163:2500-2504.

Background  Global health care costs in Canada and the United States have been examined on a macroeconomic level. However, to our knowledge, comparative costs of specific procedures in the 2 countries have not been closely studied.

Methods  To perform a microeconomic comparison of costs of open abdominal aortic aneurysm (AAA) repair, we examined the costs of treating 1057 consecutive patients from 4 Canadian (n = 552) and 6 US (n = 505) hospitals. Participating hospitals used the same cost accounting system that provided demographic, clinical, and cost data (excluding physician's fees) for each patient. Canadian dollar costs were converted to US dollar costs using purchasing power parities.

Results  Compared with patients who underwent AAA repair in the United States, Canadian patients were significantly younger (mean ± SD, 70.2 ± 10.5 vs 73.3 ± 8.5 years; P<.001) and were less likely to undergo elective repair (48.5% vs 73.3%; P<.001). The median length of hospital stay was longer in Canada (9.0 vs 7.0 days; P<.001), and mortality rates were similar (12.0% [Canada] vs 9.9% [United States]; P = .29). The mean ± SEM cost of AAA repair was $15 852 ± $790 in Canada compared with $23 299 ± $1410 in the United States.

Conclusions  The cost of AAA repair is substantially higher in the United States compared with Canada, despite shorter lengths of stay and similar clinical outcomes. The difference in total treatment costs between Canadian and American hospitals was partially attributable to differences in direct costs, but was largely due to differences in overhead costs.

From the Divisions of Cardiology and Epidemiology (Ms Brox, Messrs Filion and Azoulay, and Dr Eisenberg) and Vascular Surgery (Dr Obrand), Jewish General Hospital/McGill University, Montreal, Quebec; Division of Clinical Epidemiology, Montreal General Hospital/McGill University, Montreal, Quebec (Mr Zhang and Dr Pilote); and WWOR Product Development Group, Pfizer Inc, Groton/New London, Conn (Ms Haider). Ms Haider is an employee of Pfizer Inc.

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