An Innovative Cost Model for Complex VTE Procedure and Its Potential Impact to the US Health Care System

Purpose: Our institution oversees a health care network comprising 1300 beds. Following the establishment of a Venous Thromboembolism Program, we have successfully performed over 650 mechanical thrombectomy procedures to address various cases of Deep Vein Thrombosis (DVT). In today's medical landscape, many companies have been focusing on venous procedures. Inari Medical (Irvine, CA) has been in the forefront of purpose fully innovating not one device, but a toolkit of devices for optimally treating complex procedures. The company has also introduced the per procedure plan (PPP) cost model to minimize procedural costs while optimizing treatment strategies. This analysis aims to evaluate expenses for treating patients with complex venous interventions, especially those dealing with challenging supra-inferior Vena Cava (IVC) filter extension in bilateral iliac vessels and lower extremities.

Materials and Methods: Patients were identified retrospectively through a chart review and comprehensive practice terminology codes, along with medical records spanning from January 2018 to December 2023. Per procedure costs when using AngioVac (Vortex), Indigo (Penumbra), Toolkit prior-PPP (Inari Medical), and Toolkit PPP were estimated. The primary cost contributors in our estimations encompassed the minimum hospital stay, costs associated with tissue plasminogen activator (tPA), and expenses related to the primary therapeutic devices. Certain factors, such as the cost of the Intravascular Ultrasound (IVUS) catheter (incurred in all procedures) and venous reconstruction with stenting, were not considered in these estimations. All prices were rounded to the nearest $100.

Results: Twenty-five patients with thrombosed IVCs and supra filter thrombus extension were retrospectively identified and analyzed: Vortex (5), Penumbra (6), Inari toolkit prior-PPP (5), and Inari toolkit PPP (9). The former two always necessitated the use of tPA, ICU stay (1–2 nights), and stents. The average costs for the four procedures were $19000, $14000, $25000, and $13000, respectively. Results are summarized in Table 1.

Conclusion: This analysis showed that in a high-volume center, treating involved venous interventions can be associated with varying strategies and costs. Inari Medical's visionary pricing model covers various devices for intricate VTE cases, saving health care costs. With the health care paradigm shifting toward a value-based model, it empowers physicians by alleviating concerns about unexpected expenses in such detailed procedures. As our center's VTE program expands, our objective is to further gather data on costs and procedural times for other complex venous scenarios.

Publication History

Article published online:
02 April 2024