Modelling costs of interventional pulmonary embolism treatment: implications of US trends for a European healthcare system

Author:

Mohr Katharina12ORCID,Keeling Brent3,Kaier Klaus2,Neusius Thomas4ORCID,Rosovsky Rachel P5ORCID,Moriarty John M6ORCID,Rosenfield Kenneth7ORCID,Abele Christina18ORCID,Farmakis Ioannis T19ORCID,Keller Karsten1910ORCID,Barco Stefano111ORCID,Channick Richard N12ORCID,Giri Jay S13ORCID,Lookstein Robert A14,Todoran Thomas M1516ORCID,Christodoulou Konstantinos C1,Hobohm Lukas19ORCID,Lanno Michelle17,Reed Jamie17,Binder Harald2,Konstantinides Stavros V118ORCID,Valerio Luca1ORCID,Secemsky Eric A19ORCID

Affiliation:

1. Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz , Langenbeckstr. 1, 55131 Mainz , Germany

2. Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg , Freiburg , Germany

3. Division of Cardiothoracic Surgery, Emory University Hospital , Atlanta, GA , USA

4. Wiesbaden Business School, RheinMain University of Applied Sciences , Wiesbaden , Germany

5. Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School , Boston, MA , USA

6. Division of Interventional Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA , Los Angeles, CA , USA

7. Division of Cardiology, Massachusetts General Hospital , Boston, MA , USA

8. School of Life Sciences, University of Siegen , Germany

9. Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany

10. Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg , Heidelberg , Germany

11. Department of Angiology, University Hospital Zurich , Zurich , Switzerland

12. Pulmonary and Critical Care Division, David Geffen School of Medicine , Los Angeles, CA , USA

13. Department of Medicine, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA

14. Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai , New York, NY , USA

15. Medical University of South Carolina , Charleston, SC , USA

16. Cardiovascular Division, Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center , Charleston, SC , USA

17. The PERT Consortium™ , Nashua, NH , USA

18. Department of Cardiology, Democritus University of Thrace, University General Hospital, Dragana , 68100 Alexandroupolis , Greece

19. Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA , USA

Abstract

Abstract Aims Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is entering a growth phase in Europe following a steady increase in the USA in the past decade, but the potential economic impact on European healthcare systems remains unknown. Methods and results We built two statistical models for the monthly trend of proportion of CDT among patients with severe (intermediate- or high-risk) PE in the USA. The conservative model was based on admission data from the National Inpatient Sample (NIS) 2016–20 and the model reflecting increasing access to advanced treatment from the PERT™ national quality assurance database registry 2018–21. By applying these models to the forecast of annual PE-related hospitalizations in Germany, we calculated the annual number of severe PE cases and the expected increase in CDT use for the period 2025–30. The NIS-based model yielded a slow increase, reaching 3.1% (95% confidence interval 3.0–3.2%) among all hospitalizations with PE in 2030; in the PERT-based model, increase would be steeper, reaching 8.7% (8.3–9.2%). Based on current reimbursement rates, we estimated an increase of annual costs for PE-related hospitalizations in Germany ranging from 15.3 to 49.8 million euros by 2030. This calculation does not account for potential cost savings, including those from reduced length of hospital stay. Conclusion Our approach and results, which may be adapted to other European healthcare systems, provide a benchmark for healthcare costs expected to result from CDT. Data from ongoing trials on clinical benefits and cost savings are needed to determine cost-effectiveness and inform reimbursement decisions.

Funder

University Medical Centre Mainz

Publisher

Oxford University Press (OUP)

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