Ramakrishnan Ganesh, Beliveau Lauren, Shinn Kathryn, Gable Cara, Brinkman William, Shutze William, Gable Dennis
Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
Division of Vascular and Endovascular Surgery, Baylor Scott and White The Heart Hospital - Plano, Plano, Texas.
Proc (Bayl Univ Med Cent). 2023 May 22;36(4):422-426. doi: 10.1080/08998280.2023.2212585. eCollection 2023.
Thoracic endovascular aortic repair (TEVAR) involving landing zone 2 can require extra-anatomic debranching (SR-TEVAR) to ensure left subclavian artery perfusion, resulting in increased costs. A single-branch device (Thoracic Branch Endoprosthesis [TBE], WL Gore, Flagstaff, AZ) provides a total endovascular solution. Comparative cost analysis of patients undergoing zone 2 TEVAR requiring left subclavian artery preservation with TBE versus SR-TEVAR is presented.
A single-center retrospective cost analysis was performed for aortic diseases requiring a zone 2 landing zone (TBE vs. SR-TEVAR) from 2014 to 2019. Facility charges were collected from the universal billing form UB-04 (form CMS 1450).
Twenty-four patients were included in each arm. There were no significant differences in the overall mean procedural charges between the two groups: TBE, $209,736 ($57,761) vs. SR-TEVAR $209,025 ($93,943), = 0.94. TBE resulted in reduced operating room charges ($36,849 [$8750] vs. $48,073 [$10,825], = 0.02) and reduced intensive care unit and telemetry room charges, which did not reach statistical significance ( = 0.23 and 0.12, respectively). Device/implant charges were the primary cost driver in both groups. Charges associated with TBE were significantly higher: $105,525 ($36,137) vs. $51,605 ($31,326), > 0.01.
TBE had similar overall procedural charges despite higher device/implant-related expenses and reduced facility resource utilization (lower operating room, intensive care unit, telemetry, and pharmacy charges).
累及锚定区2的胸主动脉腔内修复术（TEVAR）可能需要解剖外分支术（SR-TEVAR）以确保左锁骨下动脉灌注，从而导致成本增加。单分支装置（胸部分支血管内假体 [TBE]，WL Gore公司，弗拉格斯塔夫，亚利桑那州）提供了一种完全腔内解决方案。本文对需要保留左锁骨下动脉的锚定区2 TEVAR患者使用TBE与SR-TEVAR进行了成本比较分析。
对2014年至2019年需要锚定区2（TBE与SR-TEVAR）的主动脉疾病进行了单中心回顾性成本分析。从通用计费表单UB-04（CMS 1450表单）收集机构费用。
每组纳入24例患者。两组的总体平均手术费用无显著差异：TBE为209,736美元（57,761美元），SR-TEVAR为209,025美元（93,943美元），P = 0.94。TBE导致手术室费用降低（36,849美元 [8750美元] 对48,073美元 [10,825美元]，P = 0.02），重症监护病房和遥测室费用降低，但未达到统计学显著性（分别为P = 0.23和0.12）。装置/植入物费用是两组的主要成本驱动因素。与TBE相关的费用显著更高：105,525美元（36,137美元）对51,605美元（31,326美元），P > 0.01。
尽管与装置/植入物相关的费用较高且设施资源利用率降低（手术室、重症监护病房、遥测和药房费用较低），但TBE的总体手术费用相似。
