Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of South Florida, Tampa, Fla.
J Vasc Surg. 2018 Apr;67(4):1170-1180.e4. doi: 10.1016/j.jvs.2017.08.055. Epub 2017 Oct 23.
Lower extremity bypass (LEB) remains the gold standard revascularization procedure in patients with peripheral arterial disease. The cost of LEB substantially varies based on patient's characteristics and comorbidities. The aim of this study was to assess regional variation in infrainguinal LEB cost and to identify the specific health care expenditures per service that are associated with the highest cost in each region.
We identified adult patients who underwent infrainguinal LEB in the Premier database between June 2009 and March 2015. Generalized linear regression models were used to report differences between regions in total in-hospital cost and service-specific cost adjusting for patient's demographics, clinical characteristics, and hospital factors.
A total of 50,131 patients were identified. The median in-hospital cost was $13,259 (interquartile range, $9308-$19,590). The cost of LEB was significantly higher in West and Northeast regions with a median cost of nearly $16,000. The high cost in the Northeast region was driven by the fixed (indirect) cost, whereas the driver of the high cost in the West region was the variable (direct) cost. The adjusted total in-hospital cost was significantly higher in all regions compared with the South (mean difference, West, $3752 [95% confidence interval (CI), 3477-4027]; Northeast, $2959 [95% CI, 2703-3216]; Midwest, 1586 [95% CI, 1364-1808]).
In this study, we show the marked regional variability in LEB costs. This disparity was independent from patient clinical condition and hospital factors. Cost inequality across the US represents a financial burden on both the patient and the health system.
下肢旁路（LEB）仍然是外周动脉疾病患者血管重建的金标准。LEB 的成本因患者的特征和合并症而有很大差异。本研究的目的是评估下肢旁路成本的区域差异，并确定每个区域成本最高的特定医疗服务的具体支出。
我们在 Premier 数据库中确定了 2009 年 6 月至 2015 年 3 月期间接受下肢旁路的成年患者。使用广义线性回归模型报告了不同地区之间总住院费用和特定服务费用的差异，调整了患者的人口统计学、临床特征和医院因素。
共确定了 50131 名患者。中位住院费用为 13259 美元（四分位间距为 9308 美元至 19590 美元）。西部地区和东北地区的 LEB 成本明显较高，中位成本接近 16000 美元。东北地区的高成本是由固定（间接）成本驱动的，而西部地区的高成本是由可变（直接）成本驱动的。与南部地区相比，所有地区的调整后总住院费用均显著升高（平均差异，西部地区为 3752 美元[95%置信区间（CI）为 3477-4027]；东北部地区为 2959 美元[95%CI 为 2703-3216]；中西部地区为 1586 美元[95%CI 为 1364-1808]）。
在这项研究中，我们展示了 LEB 成本的显著区域差异。这种差异独立于患者的临床状况和医院因素。美国各地的成本不平等给患者和医疗体系带来了经济负担。
