Economic Implications of Endovascular Procedures for Peripheral Arterial Disease Across Different Sites of Care

Purpose: Endovascular procedures for treatment of peripheral arterial disease (PAD) grew by an average of 20% between 2011 to 2018. Limited literature is available on the location of service and its impact on cost and quality of care in PAD. This study sought to understand the economic implications of PAD procedures on patients within different sites of care, including inpatient (IP), outpatient hospital (OPH), and office-based laboratory (OBL).

Materials and Methods: We conducted a retrospective review of available national Medicare data from 2011 to 2018 on commonly performed lower extremity peripheral endovascular procedures. Analysis of site of care and cost of procedure were performed. Percutaneous transluminal angioplasty (PTA), atherectomy, and stent placement within the iliac, femoropopliteal, and infrapopliteal vessels were analyzed. All Common Procedural Terminology (CPT) codes used for these procedures were analyzed.

Results: There has been average 20% growth in PAD procedure volume over 7 years. Overall OBL procedures are increasing, which are on average 50% more cost effective than outpatient hospitals site procedures. Iliac PTA and stent (CPT 37221) has a 100% higher median and 106% higher average cost in OPH vs OBL. Femoropopliteal PTA with stent and atherectomy (CPT 37227) has the highest adoption in OBL (59%) versus OPH (36%) versus IP (5%). Median cost at OPH ($30,464) is 90% higher than OBL ($16,800). Femoropopliteal PTA and atherectomy (CPT 37225) has a 60% higher median and 76% higher average cost in OPH versus OBL. Femoropopliteal PTA and stent (CPT 37226) has a 90% higher median and 66% higher average cost in OPH versus OBL. Infrapopliteal PTA and atherectomy (CPT 37229) has a 52% higher median and average cost in OPH versus OBL. Infrapopliteal PTA and stent (CPT 37230) has a 58% higher median and 75% higher average cost in OPH versus OBL.

Conclusions: Endovascular procedures in the OBL are consistently increasing and are on average greater than 50% more cost effective than outpatient hospital and inpatient procedures. Although OPH sites still have a significant volume, they are more expensive, whereas IP procedures remained flat. The cost–benefit analysis of endovascular therapies must be evaluated further to provide the most optimal value for patients.