Cost Analysis of Intravascular Ultrasound Guidance for Transjugular Intrahepatic Portosystemic Shunt Creation

To compare costs of intravascular ultrasound (IVUS)-guided transjugular intrahepatic portosystemic shunt (TIPS) creation versus non-IVUS-guided TIPS creation, accounting for differences in procedure time and resource utilization.

This single-institution retrospective study estimated procedure time and resource utilization from 157 consecutive elective TIPS creation procedures, of which 91 were IVUS-guided and 66 were non-IVUS-guided. Differences in procedure costs were derived using time-driven activity-based costing. The difference in post-TIPS creation length of hospital stay was included in overall episode of care cost estimates.

IVUS-guided TIPS creation was 45.5 minutes faster (P < .001) and required 35.2 mL less contrast medium (P < .001), leading to savings of $325.34 on staffing, $58.21 on medications, and $76.59 on equipment usage. However, requiring $2,100 single-use disposable catheters, IVUS guidance was $1,484.96 more costly per procedure. Following TIPS creation, the mean length of hospital stay was 1.3 days after IVUS-guided procedures versus 2.1 days after non-IVUS-guided procedures (P = .001). With an estimated cost of $2,677 per hospital day, there was an overall savings of $656.64 with IVUS-guided TIPS creation.

Improved procedural metrics during TIPS creation alone are unlikely to offset the costs of IVUS guidance. However, based on improvements in immediate post-TIPS creation clinical outcomes, which may translate into shorter hospitalization, IVUS guidance is likely to reduce overall costs for the episode of care related to TIPS creation.