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How Does the Rate of Adaption of Percutaneous Venous Mechanical Thrombectomy Affect Clinical and Financial Outcomes Within a Healthcare System
Mallory Thompson
1, Brittany Cross
2, Brian C Adams
2 1Rocky Vista University, Saint George, UT;
2Intermountain Health, Provo, UT
INTRODUCTION: Deep venous thrombosis (DVT) has a national annual incidence of 900,000 cases, costs five to eight billion dollars, and an overall mortality rate of 6%. Over the last decade, several studies have shown the potential clinical benefits of early percutaneous thrombectomy of iliofemoral DVT. Previously, catheter-directed thrombolysis was the only option for treatment; however, over the last 10 years percutaneous mechanical venous thrombectomy (PMT) has proven to be a viable option for treatment and has seen a rapid expansion of device options become available. Each device company touts cost savings as a significant reason to favor PMT over catheter-directed thrombolysis (CDT). To-date, there is little published data to qualify these assertions. Clinically, PMT has demonstrated several advantages over CDT and the cost-effectiveness of PMT has been recognized. However, these metrics have not been reported in a study within a hospital system. This study seeks to evaluate the rate of adoption of PMT within a healthcare system and how those different rates have impacted patients clinically as well as quantify the financial impact.
METHODS: A retrospective observational analysis was performed of the 1,447 DVT treatments performed at four Intermountain Health hospitals in Utah from January 2018 to June 2024. Data was analyzed using Tableau to examine the clinical outcomes and financial metrics of PMT versus traditional CDT. We observed significantly different rates of adoption of PMT between hospitals. Using this difference, we compared clinical outcomes and financial metrics. Risk stratification was then performed to evaluate if a patient’s risk level affected financial metrics as well as 30-day outcomes.
RESULTS: Those hospitals with earlier adoption of PMT had significantly fewer average charges per hospital stay as well as a shorter length of stay. The early adopting hospitals had a length of stay of 1.7 days shorter than the other hospitals as well as average charges of $31,006 less than the hospitals that were slower to transition to PMT. After risk-stratification, we also observed a similar 30-day readmission rate and fewer complications when CDT was compared to PMT.
CONCLUSIONS: This study gives an accurate depiction of a regional system with risk stratification to better quantify the benefits that exist with the continued move towards PMT to treat iliofemoral DVT. This study has shown that PMT, when evaluated from a financial and clinical perspective, leads to lower costs, decreased length of stay, and lower complication rates with similar clinical outcomes. Given these results, further studies expanding and confirming this data should be conducted to provide further evidence of the utility and effectiveness of PMT.
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