Radiologic versus surgical placement of vena cava filters: a comparative study of cost, time and complications

To compare the cost- and time-effectiveness of 2 methods of placement of vena cava filters for the prevention of pulmonary embolism: the radiologic percutaneous placement of the Vena Tech LGM filter and the surgical cutdown placement of the 24 Fr Greenfield filter.

Retrospective review of radiologic and clinical records for 15 consecutive patients who had the Vena Tech LGM filter placed radiologically and 15 consecutive patients who had the Greenfield filter placed surgically. Factors studied were cost, procedure time, waiting time and rates of immediate and delayed complications. The follow-up period ranged from 1 to 26 months (mean 7 months).

The procedure cost for the radiologic method was $702 less than for the surgical method. The procedure time for the radiologic method was 30 minutes shorter, and the waiting time for placement was also shorter. There was no difference in the complication rates following each procedure. The higher cost of the Greenfield filter accounted for 80% of the total cost difference.

The radiologic percutaneous method of filter placement is preferred over the surgical cutdown method because of its benefits in terms of cost and time with no increase in risk. However, when the difference in cost between filters is taken into account, there is little difference in overall costs for the 2 methods. Therefore, radiology and surgery departments can place a filter percutaneously at a similar cost. Other factors such as waiting times, complication rates, venography capabilities and physician interest in performing the procedure will dictate which department places the filter.