National Trends in Aneurysm Care: Rising Volumes, Greater Efficiency, and Shrinking Surgeon Reimbursement

Over the past 2 decades, management of aortic, peripheral, and visceral artery aneurysms has been transformed by endovascular techniques, resulting in a growing number of treated patients. Despite this expansion, vascular surgeon reimbursement has steadily declined. We evaluated national expenditure trends for aneurysm care relative to US gross domestic product and healthcare sector output to contextualize the evolving economic landscape facing vascular surgeons.

We analyzed nationally representative data from the Medical Expenditure Panel Survey and the National Income and Product Accounts from 2000 to 2021. Outcomes included annual aneurysm-related episodes, total expenditures, per capita spending, and cost per case. Trends were assessed using least squares regression. Expenditures were net of drug rebates and examined using indices of per capita spending and overall medical care expenditures. A derived prevalence index (treated prevalence = per capita index/medical care expenditure index) reflected changes in the proportion of patients treated over time. Medicare reimbursement data (2011-2021) were incorporated to provide surgeon-level payment context.

From 2000 to 2021, aneurysm-related episodes increased by approximately 41,000 cases annually (P < 0.0001). Total expenditures rose by $98 million per year (P < 0.0001), while cost per case declined by $11.33 annually (P = 0.011). Per capita spending increased steadily (0.0263/year, P < 0.0001), whereas Medical Care Expenditure Index declined (-0.0039/year, P = 0.011). The prevalence index increased by 0.0335 per year (P < 0.0001).

Aneurysm care has expanded with increasing efficiency and declining per-case costs. However, Medicare reimbursement has eroded, highlighting a growing disconnect between clinical productivity and Medicare payment.