Lower extremity endovascular interventions: can we improve cost-efficiency?

Area of Science:

• Vascular Surgery
• Health Economics
• Interventional Radiology

Background:

• Endovascular interventions for lower extremity arterial disease are increasing.
• Practice patterns for these interventions vary significantly.
• There is a need to evaluate cost-efficiency and reimbursement strategies.

Purpose of the Study:

• To evaluate reimbursement and costs of different endovascular intervention approaches.
• To identify strategies for improving cost-efficiency in endovascular interventions.
• To analyze financial outcomes based on procedure setting and admission status.

Main Methods:

• Retrospective review of 296 endovascular interventions performed in a university health system in 2005.
• Data collected included procedure type, setting, admission status, and financial data.
• Statistical comparison using ANOVA, Student t test, and chi-squared tests.

Main Results:

• Procedures in the operating room were more costly than in the radiology suite (e.g., stenting: $6596 vs $4867).
• Ambulatory procedures in the radiology suite were the most cost-efficient ($5714), while inpatient procedures in the operating room were the most expensive ($12,278).
• Inpatient admissions yielded higher reimbursement and contribution margins, with net profit only seen for inpatient procedures in the radiology suite.

Conclusions:

• Endovascular intervention costs and reimbursement vary significantly by procedure and setting.
• Designating the radiology suite as the primary venue and considering selective stenting can improve cost-efficiency.
• Optimizing Current Procedural Terminology (CPT) coding and negotiating contracts with private insurers are crucial for fiscal viability of ambulatory endovascular interventions.