Cost analysis of mechanical thrombectomy vs catheter-directed thrombolysis vs anticoagulation alone for pulmonary...

Pulmonary embolism is the third most common cause of cardiovascular death in the US with a high financial burden. Data on cost-analysis is limited in comparing advanced treatment modalities.

A cohort of patients were selected from a PERT registry database from cases at a tertiary center in a metropolitan area between 2016 and 2023. Patients were treated with either anticoagulation alone, CDT, or MT. The primary outcome was revenue-per-case.

MT had the highest revenue-per-case, with a median (IQR) of $59,058 ($42,827-$86,950) (p < 0.0001). CDT had a median (IQR) revenue-per-case of $19,007 ($14,062-$34,651). Anticoagulation alone had a median (IQR) revenue-per-case of $16,171 ($12,666-$31,473). Margin-per-case closely paralleled the primary outcome. While hospital length of stay, survival at discharge, and 90-day readmission were not different among the groups, ICU utilization was 20 % in anticoagulation patients, 100 % in CDT patients, and 24 % in MT patients (p < 0.0001). CTEPH was identified in 12 % of the anticoagulation group, 12 % of the CDT patients, and none of the MT patients (p = 0.04).

MT has a significantly higher revenue-per-case compared with anticoagulation alone and CDT. ICU utilization of mechanical thrombectomy was lower than catheter-directed thrombolysis and near the ICU utilization with anticoagulation alone. Institution policies and device choice may impact these outcomes, which may vary by center.

Advanced therapies that can prevent the downstream sequalae of PE have higher cost but may be more advantageous, and further research is required to evaluate long term benefits.