Lesion complexity drives the cost of superficial femoral artery endovascular interventions

Abstract

Objective: Patients who undergo endovascular treatment of superficial femoral artery (SFA) disease vary greatly in lesion complexity and treatment options. This study examined the association of lesion severity and cost of SFA stenting and to determine if procedure cost affects primary patency at 1 year.

Methods: A retrospective record review identified patients undergoing initial SFA stenting between January 1, 2010, and February 1, 2012. Medical records were reviewed to collect data on demographics, comorbidities, indication for the procedure, TransAtlantic Inter-Society Consensus (TASC) II severity, and primary patency. The interventional radiology database and hospital accounting database were queried to determine cost drivers of SFA stenting. Procedure supply cost included any item with a bar code used for the procedure. Associations between cost drivers and lesion characteristics were explored. Primary patency was determined using Kaplan-Meier survival curves and a log-rank test.

Results: During the study period, 95 patients underwent stenting in 98 extremities; of these, 61% of SFA stents were performed for claudication, with 80% of lesions classified as TASC II A or B. Primary patency at 1 year was 79% for the entire cohort. The mean total cost per case was $10,333. Increased procedure supply cost was associated with adjunct device use, the number of stents, and TASC II severity. Despite higher costs of treating more complex lesions, primary patency at 1 year was similar at 80% for high-cost (supply cost >$4000) vs 78% for low-cost (supply cost <$4000) interventions.

Conclusions: SFA lesion complexity, as defined by TASC II severity, drives the cost of endovascular interventions but does not appear to disadvantage patency at 1 year. Reimbursement agencies should consider incorporating disease severity into reimbursement algorithms for lower extremity endovascular interventions.

Conflict of interest statement

Author conflict of interest: none.

Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Fig 1

Superficial femoral artery (SFA) stent primary patency at 1 year was 81% for TransAtlantic Inter-Society Consensus (TASC) II A and B lesions, and the standard error at 1 year was 5%. Primary patency at 1 year was 67% for TASC II C and D lesions, and the standard error at 1 year was 13%. No statistical difference was identified. NS, Not significant.

Fig 2

TransAtlantic Inter-Society Consensus (TASC) II severity is related to procedure supply cost, which was significantly greater for TASC II C and D lesions ($6079) vs TASC II A and B lesions ($3130). *P < .01. Smaller differences in cost were found for the other cost categories: the mean interventional radiology (IR) suite cost was $1610 for TASC II A and B vs $1966 for TASC II C and D (P = .16). The mean recovery room cost was $404 for TASC II A and B vs $429 for TASC II C and D (P = .51). The mean medication and laboratory cost was $52 for TASC II A and B vs $58 for TASC II C and D (P = .42).

Fig 3

Procedure supply cost increases as TransAtlantic Inter-Society Consensus (TASC) II severity increases. A statistically significant trend was identified for procedure cost and TASC II severity (P < .01).

Fig 4

Procedure supply cost was increased for chronic total occlusions (CTOs). High-cost interventions were defined as interventions with a procedure supply cost >$4000. The primary patency at 1 year was 80% for high-cost interventions vs 78% for low-cost interventions, with a standard error of <10% at all time points (P = .63).

Fig 5

Primary patency stratified by high-cost vs low-cost intervention. High-cost interventions were defined as interventions with a procedure supply cost >$4000. Primary patency at 1 year was 80% for high-cost interventions vs 78% for low-cost interventions, with a standard error of P = .63). NS, Not significant.