Abstract
PURPOSE: To examine the cost implications of intravascular ultrasound (US) in lower extremity deep venous intervention.
MATERIALS AND METHODS: This retrospective cohort study analyzed Medicare claims data from 2016 to 2021 for beneficiaries aged ≥65 years undergoing lower extremity venous interventions. Gamma regression adjusted for demographics and comorbidities assessed cost ratios for intravascular US-guided versus non-intravascular US-guided procedures standardized to duration of follow-up. Rates of rehospitalization for causes attributable to complications of intervention were compared between intravascular US-guided and non-intravascular US-guided procedures by Cox regression. Results are shown as estimates with 95% CIs.
RESULTS: Among 52,610 patients, 42.6% underwent intravascular US-guided procedures including stent placement, thrombolysis, or thrombectomy. Intravascular US use was highest in outpatient settings (75.3%) and ambulatory surgical center (ASC)/office-based laboratory (OBL; 86.4%) and lowest in inpatient settings (10.4%). In all settings, intravascular US use was associated with cost savings. In the inpatient setting, intravascular US guidance was associated with a cost ratio of 0.91 (95% CI, 0.88-0.95) at 90 days, compared with 0.71 (95% CI, 0.68-0.73) in ASC/OBL and 0.73 (95% CI, 0.71-0.76) in hospital-based outpatient settings. Cost savings persisted at 1- and 3-year follow-ups. Intravascular US guidance was associated with lower 1-year complication-related hospitalization in outpatient procedures (hazard ratio [HR], 0.73; 95% CI, 0.62-0.86) and ASC/OBL procedures (HR, 0.78; 95% CI, 0.66-0.91). Cost savings were present in stent placement procedures at 90 days (cost ratio, 0.71; 95% CI, 0.68-0.73), whereas there was cost neutrality in thrombectomy (cost ratio, 1.02; 95% CI, 0.97-1.08) and thrombolysis (cost ratio, 0.89; 95% CI, 0.75-1.05).
CONCLUSIONS: Intravascular US-guided venous intervention was associated with durable cost savings and reductions in rehospitalization in all procedural settings among procedures involving stent deployment.