Lesion complexity drives the cost of superficial femoral artery endovascular interventions
Karen L Walker1, Brian W Nolan1, Jesse A Columbo1
1Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Insights
Superficial femoral artery (SFA) stenting costs increase with lesion complexity but do not impact 1-year primary patency. Disease severity should inform reimbursement for endovascular interventions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Health Economics
Background:
- Superficial femoral artery (SFA) disease treatment varies in complexity and cost.
- Endovascular stenting is a common treatment option for SFA disease.
Purpose of the Study:
- To examine the association between lesion severity and the cost of SFA stenting.
- To determine if procedure cost affects primary patency at 1 year.
Main Methods:
- Retrospective review of 95 patients undergoing SFA stenting (2010-2012).
- Data collected included demographics, comorbidities, TASC II severity, and primary patency.
- Cost drivers were identified from interventional radiology and hospital accounting databases.
Main Results:
- Mean cost per case was $10,333; higher costs linked to adjunct devices, stent number, and TASC II severity.
- 1-year primary patency was 79% overall.
- High-cost interventions (> $4000 supply cost) showed similar 1-year patency (80%) to low-cost (< $4000) interventions (78%).
Conclusions:
- SFA lesion complexity (TASC II severity) influences intervention costs but not 1-year patency.
- Reimbursement policies should consider disease severity for lower extremity endovascular interventions.
Objective:
Patients who undergo endovascular treatment of superficial femoral artery (SFA) disease vary greatly in lesion complexity and treatment options. This study examined the association of lesion severity and cost of SFA stenting and to determine if procedure cost affects primary patency at 1 year.
Methods:
A retrospective record review identified patients undergoing initial SFA stenting between January 1, 2010, and February 1, 2012. Medical records were reviewed to collect data on demographics, comorbidities, indication for the procedure, TransAtlantic Inter-Society Consensus (TASC) II severity, and primary patency. The interventional radiology database and hospital accounting database were queried to determine cost drivers of SFA stenting. Procedure supply cost included any item with a bar code used for the procedure. Associations between cost drivers and lesion characteristics were explored. Primary patency was determined using Kaplan-Meier survival curves and a log-rank test.
Results:
During the study period, 95 patients underwent stenting in 98 extremities; of these, 61% of SFA stents were performed for claudication, with 80% of lesions classified as TASC II A or B. Primary patency at 1 year was 79% for the entire cohort. The mean total cost per case was $10,333. Increased procedure supply cost was associated with adjunct device use, the number of stents, and TASC II severity. Despite higher costs of treating more complex lesions, primary patency at 1 year was similar at 80% for high-cost (supply cost >$4000) vs 78% for low-cost (supply cost <$4000) interventions.
Conclusions:
SFA lesion complexity, as defined by TASC II severity, drives the cost of endovascular interventions but does not appear to disadvantage patency at 1 year. Reimbursement agencies should consider incorporating disease severity into reimbursement algorithms for lower extremity endovascular interventions.
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