Mell Matthew W, Garg Trit, Baker Laurence C
Department of Vascular Surgery, Stanford School of Medicine, Stanford, CA.
Department of Vascular Surgery, Stanford School of Medicine, Stanford, CA.
Ann Vasc Surg. 2017 Oct;44:54-58. doi: 10.1016/j.avsg.2017.03.203. Epub 2017 May 10.
Since 2009, the Society for Vascular Surgery has advocated annual surveillance imaging with ultrasound (US) after the first postoperative year for uncomplicated endovascular aneurysm repairs (EVARs). We sought to describe diffusion of US into long-term routine surveillance and to estimate potential cost savings among Medicare beneficiaries after EVAR.
Using Medicare claims data, we identified patients receiving EVAR from 2002 to 2010 and included only those who did not subsequently have reinterventions, late aneurysm-related complications, or death. We collected all relevant postoperative imaging (computed tomography [CT] and US) through 2011. Patients with follow-up less than 1 year were excluded. We estimated cost savings with increased use of US after the first postoperative year.
The cohort comprised 24,615 patients with a mean follow-up of 3.9 ± 2.3 years. Mean number of images decreased from 2.23 in the first postoperative year to 0.31 in the 10th year. Utilization of US at the first postoperative year remained low but increased from 15.2% in 2003 to 28.8% in 2011 (P < 0.001). By the 10th postoperative year, the proportion of patients receiving US increased from 8.2% to 37.8%, while use of CT only remained high but decreased from 60.8% to 42.1%. Mean cost of surveillance imaging was $2,132/CT and $234/US. Performing US in 50-75% of patients beginning 1 year after EVAR would decrease costs by 14-48%/year. This translates to a mean cost savings of $338-$1135 per imaged patient per year, with an estimated savings to Medicare of $155 million to $305 million over 10 years.
CT remains the primary modality of surveillance for up to 10 years after EVAR for patients without reinterventions or aneurysm-related complications. Increasing the use of US and decreasing the use of CT would save cost without compromising outcomes.
自2009年以来，血管外科学会主张对未发生并发症的血管内动脉瘤修复术（EVAR）患者，在术后第一年之后每年进行超声（US）监测成像。我们试图描述超声在长期常规监测中的推广情况，并估计EVAR术后医疗保险受益人的潜在成本节约情况。
利用医疗保险理赔数据，我们确定了2002年至2010年接受EVAR的患者，仅纳入那些随后未进行再次干预、未发生晚期动脉瘤相关并发症或死亡的患者。我们收集了截至2011年所有相关的术后成像（计算机断层扫描[CT]和超声）。随访时间少于1年的患者被排除。我们估计了术后第一年之后增加超声使用量所带来的成本节约。
该队列包括24,615名患者，平均随访时间为3.9±2.3年。图像平均数量从术后第一年的2.23张降至第10年的0.31张。术后第一年超声的使用率仍然较低，但从2003年的15.2%增加到2011年的28.8%（P<0.001）。到术后第10年，接受超声检查的患者比例从8.2%增加到37.8%，而仅使用CT的比例仍然较高，但从60.8%降至42.1%。监测成像的平均成本为CT检查每次2,132美元，超声检查每次234美元。在EVAR术后1年开始，对50 - 75%的患者进行超声检查，每年成本将降低14 - 48%。这意味着每位接受成像检查的患者每年平均节约成本338 - 1135美元，预计10年内医疗保险可节约1.55亿至3.05亿美元。
对于未进行再次干预或未发生动脉瘤相关并发症的患者，CT在EVAR术后长达10年的时间里仍然是主要的监测方式。增加超声的使用并减少CT的使用将在不影响治疗效果的情况下节约成本。
