Abstract No. 86 Catheter-Directed Thrombolysis and Large-Bore Aspiration Thrombectomy in the Treatment of Pulmonary Embolism: A Single-Center Retrospective Economic Analysis

Pulmonary embolism (PE) is a leading cause of patient mortality and incurs significant financial cost on the healthcare system. Endovascular treatment with catheter-directed thrombolysis (CDT) and large-bore aspiration thrombectomy (LBAT) reduces mortality and improves long-term outcomes in PE patients; however, the economics of these treatment options requires further investigation. The aim of this study is to analyze the costs of CDT and LBAT in the management of PE. This single-center retrospective cohort study included patients with PE who received CDL or LBAT from 2019 to 2022. CDL devices included Ekos Endovascular System (Boston Scientific, Boston, Massachusetts) or Uni-Fuse (AngioDynamics, Latham, New York). LBAT devices included FlowTriever (Inari Medical, Irvine, California) or Indigo Aspiration System (Penumbra, Alameda, California). The primary endpoint was the percent difference in various cost metrics between CDT and LBAT. Cost metrics were normalized from 0 to 1 and reported as mean ± standard deviation, with statistical analysis including independent sample t-tests. Of the 189 patients identified, 145 were included in this study. 60.7% (n =88) were treated with CDT and 39.3% (n=57) received LBAT. The average age of the cohort was 64.1 ± 14.9 years with 53.1% females (n=77) and 46.9% males (n=68). Within the CDT group, 94.3% (83/88) of cases were coded by two MS-DRG designations (0175 and 0176), while in the LBAT group, 98.2% (56/57) of cases were assigned to two different MS-DRG designations (0163 and 0164). The normalized economic outcomes are presented in Table 86.1. Endovascular treatment of PE with CDT or LBAT is associated with differences in costs related to the specific device, pharmaceutical management, and total cost. There were no differences when assessing procedure cost, ICU/Step Down cost, and total payment. Further investigation is needed to determine the reasons behind these findings. To the best of our knowledge, this study provides the first reported economic assessment of endovascular therapies in the treatment of PE.