title: Lesion complexity drives the cost of superficial femoral artery endovascular interventions.
abstract: OBJECTIVE
  Patients who undergo endovascular treatment of superficial femoral artery (SFA) disease vary greatly in lesion complexity and treatment options. This study examined the association of lesion severity and cost of SFA stenting and to determine if procedure cost affects primary patency at 1 year.
  
  
  METHODS
  A retrospective record review identified patients undergoing initial SFA stenting between January 1, 2010, and February 1, 2012. Medical records were reviewed to collect data on demographics, comorbidities, indication for the procedure, TransAtlantic Inter-Society Consensus (TASC) II severity, and primary patency. The interventional radiology database and hospital accounting database were queried to determine cost drivers of SFA stenting. Procedure supply cost included any item with a bar code used for the procedure. Associations between cost drivers and lesion characteristics were explored. Primary patency was determined using Kaplan-Meier survival curves and a log-rank test.
  
  
  RESULTS
  During the study period, 95 patients underwent stenting in 98 extremities; of these, 61% of SFA stents were performed for claudication, with 80% of lesions classified as TASC II A or B. Primary patency at 1 year was 79% for the entire cohort. The mean total cost per case was $10,333. Increased procedure supply cost was associated with adjunct device use, the number of stents, and TASC II severity. Despite higher costs of treating more complex lesions, primary patency at 1 year was similar at 80% for high-cost (supply cost >$4000) vs 78% for low-cost (supply cost <$4000) interventions.
  
  
  CONCLUSIONS
  SFA lesion complexity, as defined by TASC II severity, drives the cost of endovascular interventions but does not appear to disadvantage patency at 1 year. Reimbursement agencies should consider incorporating disease severity into reimbursement algorithms for lower extremity endovascular interventions.
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Walker
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Nolan
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Columbo
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Rzucidlo
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Atkinson
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH. Electronic address: richard.j.powell@hitchcock.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powell
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D057510:Endovascular Procedures / Q000191:economics* / Q000295:instrumentation; D005260:Female; D005263:Femoral Artery / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D016896:Treatment Outcome; D014654:Vascular Patency