A new resource utilisation study of adult pulmonary embolism (PE) admissions spanning more than two decades shows that the highest cost treatment modalities were surgical embolectomy, catheter-directed embolectomy and systemic thrombolysis relative to catheter-directed thrombolysis, while catheter-directed embolectomy was the only modality associated with shorter length of stay.
National Inpatient Sample data from 1998–2021 covering nearly 1.4 million patients were plumbed for the retrospective cohort analysis, which was recently published in press in the Journal of Vascular Surgery-Venous and Lymphatic Disorders (JVS-VL). First-named author Pablo Cuartas (New York Downstate Health Sciences University, Brooklyn, USA) and colleagues looked at average cost differences between catheter-directed thrombolysis, anticoagulation, systemic thrombolysis, catheter-directed embolectomy and surgical embolectomy, as well as differences in median length of stay by treatment modality.
Amid a burgeoning armamentarium of PE treatment approaches and newly published data, Cuartas et al pinpointed the time-dependent assessment of resource utilisation in “cost-intensive” diseases like PE, noting it was “critical to optimize health system efficiency”.
They found that 1,338,332 (97.3%) underwent anticoagulation, 22,934 (1.7%) systemic thrombolysis, 8,363 (0.6%) catheter-directed thrombolysis, 3,453 (0.3%) catheter-directed embolectomy, and 2,337 (0.2%) surgical embolectomy. “The treatment modality implemented was an independent predictor of the cost of hospitalisation,” Cuartas and colleagues reported. “Compared to catheter-directed thrombolysis, surgical embolectomy added $46,156, catheter-directed embolectomy $9,042, and systemic thrombolysis $3,094 to cost, while anticoagulation was $9,707 less expensive.”
Meanwhile, the researchers noted that anticoagulation was associated with an increase in length of stay by an average of 0.24 days, systemic thrombolysis by 1.37 and surgical embolectomy by 5.61. On the other hand, catheter-directed embolectomy was associated with a shorter length of stay, on average 0.57 fewer days. “Compared to catheter-directed thrombolysis, all other treatment modalities were associated with statistically significant, albeit not always clinically meaningful different length of stay,” Cuartas et al wrote in JVS-VL.
“Our results demonstrate that systemic thrombolysis and surgical embolectomy were cost escalators relative to catheter-directed thrombolysis, and catheter-directed embolectomy was the only treatment modality that reduced hospitalisation duration,” they concluded.
