Cost per day of patency: Understanding the impact of patency and reintervention in a sustainable model of healthcare

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Background:Healthcare resource utilization is an understudied aspect of vascular surgery. Initial cost of a given procedure is not an accurate reflection of resource utilization because it does not account for procedural durability and efficacy. Herein we describe an amortized cost model that accounts for procedural costs, durability, and re-intervention costs.Methods:A cost model was developed using patency data endpoints and total hospital costs (direct and indirect) associated with an inital revascularization and subsequent re-interventions. This model was applied to a retrospective database of femoropopliteal reconstructions. One hundred and eighty-three open cases were compared with 198 endovascular cases; and the endpoints of initial cost, amortized cost at 12 months, and assisted patency were examined.Results:The open and endovascular cases were not statistically different with respect to indication, patient co-morbid profiles, or post-procedural pharmacotherapy. Primary assisted patency was better in the open revascularization group at 12 months (78% versus 66%,P< .01). There was a statistically significant higher initial cost for open reconstruction when compared with endovascular ($12,389 ± $408 versus $6,739 ± $206,P< .001). However, at 12 months post-procedure, the initial cost benefit was lost for endovascular patients ($229 ± $106 versus $185 ± $124,P= .71). There was, however, a trend for endovascular cost savings in claudicants, though this did not reach significance ($259 ± $189 versus $86 ± $52,P= .31). For patients with critical limb ischemia, renal dysfunction, and end stage renal disease, the trend favored open surgery.Conclusions:An amortized cost model provides insight into the healthcare resource utilization associated with a particular revascularization and assistive procedures. The initial cost savings of endovascular therapies are not sustained over time. Cost-savings trends were noted, however, longer follow-up is required to see if these will reach statistical significance.

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