Unraveling the Economics of Pulmonary Embolism Care in a 23-Year Resource Utilization Study

ABSTRACT Introduction Systematic assessment of resource utilization in cost-intensive diseases such as pulmonary embolism (PE) is important to optimize health system efficiency. We examined the association between treatment modality, cost, and length of stay among inpatients diagnosed with PE. Methods Using the National Inpatient Sample (1998-2021), we performed a retrospective trend analysis. Inpatient charges were converted to costs using the cost-to-charge ratio. Average cost differences, between catheter-directed thrombolysis, anticoagulation, systemic thrombolysis, catheter-directed embolectomy, and surgical embolectomy, were assessed using survey-weighted linear regressions, with hospital clustering. Differences in median length of stay, by treatment modality, were modeled using quantile regression. Results The sample included 1,375,419 admissions. 1,338,332 (97.3%) received anticoagulation; 22,934 (1.7%) underwent systemic thrombolysis; 8,363 (0.6%) underwent catheter-directed thrombolysis; 3,453 (0.3%) underwent catheter-directed embolectomy; and 2,337 (0.2%) underwent surgical embolectomy. Compared to catheter-directed thrombolysis surgical embolectomy, catheter-directed embolectomy, and systemic thrombolysis were associated with higher average costs (surgical embolectomy=+$46,156; catheter-directed embolectomy=+$9,042; systemic thrombolysis=+$3,094, respectively; all p<0.001), while anticoagulation was less expensive ($9,707 less expensive; p<0.001). Median length of stay was longer after anticoagulation (+0.2 days), systemic thrombolysis (+1.4 days), and surgical embolectomy (+5.6 days; all p<0.001). Catheter-directed embolectomy was associated with shorter median length of stay (-0.6; p<0.001). Conclusion Substantial cost disparities exist among PE treatment modalities, spanning thousands of dollars. Although catheter-directed embolectomy was associated with the shortest median length of stay, the least expensive treatment modality was anticoagulation while the most expensive was surgical embolectomy. These insights offer guidance for optimizing resource allocation strategies in managing this prevalent postoperative complication.