Episode-based cost reduction for endovascular aneurysm repair

Area of Science:

• Vascular Surgery
• Health Economics
• Healthcare Management

Background:

• Endovascular aneurysm repair (EVAR) costs present a significant challenge for healthcare institutions.
• Effective strategies for reducing EVAR-related expenses are crucial for sustainable healthcare delivery.
• Previous efforts to control EVAR costs have had limited success in many medical centers.

Purpose of the Study:

• To identify and implement targeted interventions aimed at reducing inpatient costs associated with EVAR.
• To analyze the impact of these interventions on procedure-related expenses at a high-volume academic medical center.
• To evaluate cost savings in key areas: implants, rooming, and computed tomography (CT) scans.

Main Methods:

• A comparative analysis of direct per-patient hospital costs before (September 2013-May 2015) and after (March 2016-January 2017) intervention implementation.
• Focused improvement efforts on implants, rooming costs, and CT scans, which constitute a majority of EVAR expenses.
• Implemented new purchasing strategies for implants and modified care pathways for imaging and preprocedural rooming.

Main Results:

• Per-case device costs decreased by 30.8% through new purchasing strategies.
• Per-case imaging costs reduced by 92.9%, with a 99.0% decrease in postprocessing costs.
• Preprocedural rooming utilization decreased by 50% without significantly impacting length of stay; hospital-wide medication costs also fell by 38.2%.

Conclusions:

• Targeted cost-reduction efforts for EVAR can achieve substantial savings.
• These strategies effectively reduce expenses without compromising procedural quality or patient access.
• Implementing focused interventions is vital for the financial sustainability of EVAR programs.