A Cost Analysis of Intravascular Ultrasound during Lower Extremity Deep Venous Interventions among Medicare Beneficiaries.

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.