Inferring acute economic aspects of endovascular deep vein thrombosis management from a literature-based comparative cohort analysis

Objective This study was an inferential analysis aimed to estimate 30-day episode care costs associated with four contemporary endovascular therapies indicated for the treatment of deep vein thrombosis (DVT). Methods Source data were extracted from a systematic literature review of publications that reported outcomes after DVT intervention with mechanical thrombectomy (MT), aspiration thrombectomy with capital equipment (AT), ultrasound-facilitated catheter-directed thrombolysis (US-CDT), and rheolytic thrombectomy (RT). Case reports or series with fewer than 10 subjects, interim or subanalyses, and pediatric patients were excluded. Total episode care costs were defined as the sum of device and therapeutic costs, acute care costs, and contingent costs (ie, comprised bleeding, acute kidney injury, and readmissions) through 30 days. Results Through July 2023, 45 studies representing 2581 patients informed the analysis. The total episode cost per patient was estimated at $10,682, $14,073, $16,177, and $19,669 for MT, AT, US-CDT, RT, respectively. Device costs constituted the largest component of total episode costs at $8228, $9105, $5883, and $8862, respectively. Thrombolytic medications were a more significant driver of cost for US-CDT ($2982) and RT ($2412), relative to MT ($22) and AT ($931). Acute care costs included primary and adjunctive procedure suites, hospital stay, and intensive care unit monitoring and were estimated at $1723, $2875, $4014, and $4416, respectively. Contingent costs were estimated at $709, $1163, $3298, and $3980, respectively. Conclusions Endovascular strategies for the treatment of acute DVT that avoided thrombolytics saw shortened length of stay, reduced the need for intensive care unit level care, and minimized postprocedure bleeding and 30-day readmissions. These factors favored MT with the lowest episode costs.