Tran Anne, Toma Catalin, Jaber Wissam, Heintz Jonathan, Matthai William H, Palevsky Harold, Giri Jay, Kobayashi Taisei J, Nathan Ashwin S, Baumgartner Scott, Bashline Michael, Inci Errol K, Khandhar Sameer J
Penn Presbyterian Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
University of Pittsburgh Medical Center; Heart and Vascular Institute, Pittsburgh, Pennsylvania.
J Soc Cardiovasc Angiogr Interv. 2023 Oct 14;3(2):101187. doi: 10.1016/j.jscai.2023.101187. eCollection 2024 Feb.
Catheter-directed thrombolysis (CDT) and large-bore mechanical thrombectomy (MT) are the leading percutaneous-based therapies for the management of intermediate-risk pulmonary embolism (PE). While previous studies have demonstrated their procedural safety and efficacy, the cost implications of these interventions remain unclear. This study aims to conduct a cost-benefit analysis to evaluate the economic advantages associated with CDT and MT from the perspective of the treating hospital.
A total of 372 consecutive patients with intermediate-risk acute PE who underwent either MT or CDT at 3 academic centers between 2013 and 2021 were included in this analysis. The costs of care incurred during the index hospitalization for the 2 treatment groups were collected and compared using an adjusted cost model.
This study compared the hospital costs of 226 patients who underwent CDT and 146 patients who underwent MT. In the unadjusted overall cohort, the use of CDT was associated with a numerical but nonsignificant increase in costs amounting to $5120 relative to MT ( = .062). This cost difference was primarily driven by the longer length of stay in the intensive care unit and hospital for CDT patients, particularly earlier in the studied timeframe. However, when accounting for confounders including variations between the treating institutions and the timing of treatment during the study period, the adjusted cost differential between CDT and MT narrowed to $1351 ( = .71).
This multicenter cost analysis does not reveal a clear cost advantage of 1 treatment over the other for intermediate-risk PE. The observed cost differences were influenced by variations in practice patterns across the study period and among the 3 participating institutions. Future efforts should also focus on strategies to reduce the length of stay, improve efficiency, and minimize the overall cost of care for intermediate-risk PE patients.
导管直接溶栓术（CDT）和大口径机械血栓切除术（MT）是治疗中度风险肺栓塞（PE）的主要经皮治疗方法。虽然先前的研究已证明其操作安全性和有效性，但这些干预措施的成本影响仍不明确。本研究旨在进行成本效益分析，从治疗医院的角度评估与CDT和MT相关的经济优势。
本分析纳入了2013年至2021年间在3个学术中心接受MT或CDT治疗的372例连续的中度风险急性PE患者。收集两个治疗组在首次住院期间产生的护理费用，并使用调整后的成本模型进行比较。
本研究比较了226例行CDT治疗的患者和146例行MT治疗的患者的住院费用。在未经调整的总体队列中，与MT相比，使用CDT的成本有数值上的增加，但无统计学意义，增加了5120美元（P = 0.062）。这种成本差异主要是由CDT患者在重症监护病房和医院的住院时间较长所致，尤其是在研究时间段的早期。然而，在考虑包括治疗机构之间的差异以及研究期间治疗时间等混杂因素后，CDT和MT之间调整后的成本差异缩小至1351美元（P = 0.71）。
这项多中心成本分析未发现一种治疗方法相对于另一种治疗方法在治疗中度风险PE方面具有明显的成本优势。观察到的成本差异受到研究期间和3个参与机构之间实践模式差异的影响。未来的努力还应侧重于缩短住院时间、提高效率以及将中度风险PE患者的总体护理成本降至最低的策略。
