To evaluate hospital costs and reimbursement for open (OAAA) and endovascular (EVAAA) repair of abdominal aortic aneurysm. Review of all patients who underwent OAAA or EVAAA in two teaching hospitals during the period January 1, 2000, to December 31, 2000, was completed for the following: demographics, Diagnosis Related Group (DRG), resource use, length of stay, hospital costs, and reimbursement data. There were 130 abdominal aortic aneurysm procedures performed. Fifty-seven (44%) OAAA were completed; EVAAA was attempted in 73 (56%). Seventy EVAAA patients (96%) had endografts placed, and three (4%) required conversion to open repair. Significant differences were noted between OAAA and EVAAA in operative time (311.7 +/- 107.5 minutes versus 263.4 +/- 110.8 minutes, respectively, p = 0.02), ICU admission and length of stay (100%, 5.0 +/- 6.1 days versus 29%, 1.4 +/- 7.1 days, respectively, p = 0.003), and hospital length of stay (12.6 +/- 14.8 days versus 4.9 +/- 13.4 days, respectively, p = 0.002). Total costs were $17,539.00 for EVAAA and $9,042.00 for OAAA. EVAAA was profitable ($3,072.00) for Medicare DRG 110 classification, but significant loss occurred with DRG 111 ($5,065.00). Contract renegotiation with private payers (to cover graft costs) was necessary to avoid substantial per- patient loss ($12,108.00). Overall net per-patient profit for EVAAA was $737.00. Endovascular abdominal aortic aneurysm repair is significantly more expensive than open repair, with the major portion attributed to graft cost. Although ICU use and total length of stay decreased with EVAAA, overall costs were not substantially reduced. Hospitals must develop new financial strategies and improve the efficiency of their infrastructures in order to offer EVAAA.