Cost drivers in endovascular pulmonary embolism interventions

• Published in: Clinical radiology 2023-02, Vol.78 (2), p.e143-e149
• Main Authors: Callese, T.E., Moriarty, J.M., Maehara, C., Cusumano, L., Mathevosian, S., Enzmann, D., Padia, S.A., Srinivasa, R.N.
• Format: Article
• Language: English
• Subjects: Fibrinolytic Agents - therapeutic use; Humans; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - surgery; Retrospective Studies; Thrombectomy - methods; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2022.09.129

To determine the costs associated with endovascular pulmonary embolism (PE) interventions. Procedural costs were determined utilising time-driven activity-based costing (TDABC). A multidisciplinary team created process maps describing personnel, space, equipment, materials, and time required for each procedural step. Costs and capacity cost rates were determined using institutional and publicly available financial data. Process maps were developed for catheter-directed thrombolysis (CDT), ultrasound-assisted thrombolysis (USAT), pharmaco-mechanical thrombectomy (PMT), mechanical-aspiration thrombectomy (MAT), and aspiration thrombectomy (AT). Total costs were CDT $3,889, USAT $9,017.10, PMT $9,565.98, AT $12,126.42, and MAT $13,748.01. Tissue plasminogen activator costs represented 46.4% of the total materials cost for CDT, 13.1% for PMT, and 10.8% for USAT. Intensive care unit costs constitute 33.4% in CDT, 13.5% in USAT, and 13.1% in PMT of the total procedure costs. Highest total procedural costs were AT and MAT with materials cost comprising 82.6% and 80.3% of total costs, respectively. Costs were greatest with large-bore mechanical aspiration and least with catheter-directed thrombolysis using a multi-side hole infusion catheter. In the absence of a reference standard technique, physician-driven device selection can substantially impact the price of a procedure. Device choice and costs must be weighed against long-term technical and clinical success to maximise the healthcare value equation. •PE intervention costs are highest with aspiration thrombectomy.•PE interventionl costs are lowest with traditional catheter-directed thrombolysis.•ICU and t-PA contribute significant costs in catheter-directed thrombolysis.•Physician device and technique selection significantly impacts procedure costs.