Cost-Comparison of Mechanical Thrombectomy and Catheter-Directed Thrombolysis in Intermediate-Risk Pulmonary Embolism

Anne Tran; Catalin Toma; Wissam Jaber; Jonathan Heintz; William H Matthai; Harold Palevsky; Jay Giri; Taisei J Kobayashi; Ashwin S Nathan; Scott Baumgartner; Michael Bashline; Errol K Inci; Sameer J Khandhar

doi:10.1016/j.jscai.2023.101187

Cost-Comparison of Mechanical Thrombectomy and Catheter-Directed Thrombolysis in Intermediate-Risk Pulmonary Embolism

J Soc Cardiovasc Angiogr Interv. 2023 Oct 14;3(2):101187. doi: 10.1016/j.jscai.2023.101187. eCollection 2024 Feb.

Authors

Affiliations

¹ Penn Presbyterian Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
² University of Pittsburgh Medical Center; Heart and Vascular Institute, Pittsburgh, Pennsylvania.
³ Emory University Hospital, Atlanta, Georgia.
⁴ Center of Clinical Epidemiology and Biostatistics, Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Background: 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.

Methods: 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.

Results: 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 (P = .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 (P = .71).

Conclusions: 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.

Keywords: catheter-directed thrombolysis; cost analysis; mechanical thrombectomy; pulmonary embolism.