Cost analysis of mechanical thrombectomy vs catheter-directed thrombolysis vs anticoagulation alone for pulmonary embolism.

Introduction: Pulmonary embolism is the third most common cause of cardiovascular death in the US with a high financial burden. Data on cost-analysis is limited in comparing advanced treatment modalities.

Methods: A cohort of patients were selected from a PERT registry database from cases at a tertiary center in a metropolitan area between 2016 and 2023. Patients were treated with either anticoagulation alone, CDT, or MT. The primary outcome was revenue-per-case.

Results: MT had the highest revenue-per-case, with a median (IQR) of $59,058 ($42,827-$86,950) (p < 0.0001). CDT had a median (IQR) revenue-per-case of $19,007 ($14,062-$34,651). Anticoagulation alone had a median (IQR) revenue-per-case of $16,171 ($12,666-$31,473). Margin-per-case closely paralleled the primary outcome. While hospital length of stay, survival at discharge, and 90-day readmission were not different among the groups, ICU utilization was 20 % in anticoagulation patients, 100 % in CDT patients, and 24 % in MT patients (p < 0.0001). CTEPH was identified in 12 % of the anticoagulation group, 12 % of the CDT patients, and none of the MT patients (p = 0.04).

Discussion: MT has a significantly higher revenue-per-case compared with anticoagulation alone and CDT. ICU utilization of mechanical thrombectomy was lower than catheter-directed thrombolysis and near the ICU utilization with anticoagulation alone. Institution policies and device choice may impact these outcomes, which may vary by center.

Conclusions: Advanced therapies that can prevent the downstream sequalae of PE have higher cost but may be more advantageous, and further research is required to evaluate long term benefits.