Cost drivers in endovascular pulmonary embolism interventions

Area of Science:

• Interventional Cardiology
• Health Economics
• Medical Device Technology

Background:

• Pulmonary embolism (PE) is a life-threatening condition requiring timely intervention.
• Endovascular techniques offer minimally invasive treatment options for PE.
• Understanding the cost implications of different PE interventions is crucial for healthcare resource allocation.

Purpose of the Study:

• To determine and compare the procedural costs of various endovascular pulmonary embolism interventions.
• To identify cost drivers within different intervention methods.

Main Methods:

• Time-driven activity-based costing (TDABC) was utilized to calculate procedural costs.
• Multidisciplinary teams developed process maps detailing personnel, space, equipment, materials, and time for each step.
• Institutional and publicly available financial data were used to determine costs and capacity cost rates.

Main Results:

• Catheter-directed thrombolysis (CDT) was the least expensive ($3,889), while mechanical aspiration thrombectomy (MAT) was the most expensive ($13,748.01).
• Tissue plasminogen activator (tPA) represented a significant portion of material costs for CDT (46.4%), PMT (13.1%), and USAT (10.8%).
• Intensive care unit (ICU) costs were highest for CDT (33.4%) compared to USAT (13.5%) and PMT (13.1%).

Conclusions:

• Endovascular pulmonary embolism intervention costs range significantly, with large-bore mechanical aspiration techniques being the most expensive.
• Catheter-directed thrombolysis is the most cost-effective option among the evaluated interventions.
• Physician-driven device selection significantly impacts procedural costs, necessitating a balance between cost, technical success, and clinical outcomes for optimal healthcare value.