Principal Health Economist, Health Economics Center of Excellence, Boston Scientific, Marlborough, Massachusetts.
Assistant Professor of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center Presbyterian Hospital (UPMC), Pittsburgh, Pennsylvania.
J Am Coll Radiol. 2022 Jun;19(6):722-732. doi: 10.1016/j.jacr.2022.03.011. Epub 2022 Apr 27.
Venous thromboembolism (VTE) imposes a significant clinical and financial burden on patients and society. Inferior vena cava filters (IVCFs) are considered for patients with absolute contraindications or failures of anticoagulation. However, studies examining the population-based disparities of IVCF placement and retrieval are limited. The association between patient and clinical characteristics in the likelihood of and time to IVCF placement and retrievals in a nationally representative cohort was examined.
Medicare patients aged ≥65 years with index VTE claims between 2015 and 2018 were followed through 2019 to identify IVCF placements and retrievals. Rates were compared using survival analysis methods.
Of the 516,978 patients with VTE diagnoses, 5,864 (1.1%) had IVCFs placed, and 1,884 (32.1%) of those underwent retrieval procedures. Placement and retrieval rates varied significantly by demographics, comorbidity burden, and geographic region. From Cox regression, older age (hazard ratio [HR], 1.26; P < .0001), higher baseline comorbidity (Elixhauser) score (HR, 1.07; P < .0001), and outpatient (vs inpatient) site of VTE service (HR, 2.11; P < .0001) were associated with increased frequency of IVCF placement. The rate of retrieval was significantly lower for men (HR, 0.83; P = .0393), patients with higher comorbidity scores (HR, 0.95; P = .0037), and those with outpatient (vs inpatient) VTE sites of service (HR, 0.77; P = .0173). Neither facility- nor county-level characteristics were significantly associated with placements or retrievals.
This large cohort of Medicare beneficiaries with newly diagnosed VTE demonstrated inequities in IVCF placement and retrieval.
静脉血栓栓塞症（VTE）给患者和社会带来了重大的临床和经济负担。对于有绝对禁忌症或抗凝治疗失败的患者，会考虑使用下腔静脉滤器（IVCF）。然而，目前关于 IVCF 放置和取出的基于人群的差异的研究有限。本研究旨在检查一个全国代表性队列中患者和临床特征与 IVCF 放置和取出的可能性和时间之间的关联。
在 2015 年至 2018 年期间，对年龄≥65 岁且有 VTE 诊断记录的 Medicare 患者进行随访，以确定 IVCF 的放置和取出情况。使用生存分析方法比较了这些患者的比率。
在 516978 例患有 VTE 诊断的患者中，有 5864 例（1.1%）患者接受了 IVCF 放置，其中 1884 例（32.1%）患者接受了取出操作。放置和取出的比率在人口统计学、合并症负担和地理区域方面存在显著差异。从 Cox 回归分析中可以看出，年龄较大（风险比[HR]，1.26；P<0.0001）、基线合并症（Elixhauser）评分较高（HR，1.07；P<0.0001）以及门诊（vs 住院）VTE 服务地点（HR，2.11；P<0.0001）与 IVCF 放置频率增加相关。男性（HR，0.83；P=0.0393）、合并症评分较高的患者（HR，0.95；P=0.0037）以及门诊（vs 住院）VTE 服务地点的患者（HR，0.77；P=0.0173）的 IVCF 取出率显著降低。设施和县级特征均与放置或取出无显著关联。
本研究中的 Medicare 受益人群队列中，新诊断出的 VTE 患者中存在 IVCF 放置和取出的不公平现象。
