Cost Analysis Of Timing Of Carotid Subclavian Revascularization In Tevar
Hunter M. Ray, MD1, Akshita Kumar, MD2, Jacob J. Siahaan, MS1, Christopher R. Conner, MD, PhD2, Kristofer M. Charlton-Ouw, MD1.
1Gulf Coast Vascular, HOUSTON, TX, USA, 2UT Health, McGovern Medical School, HOUSTON, TX, USA.
OBJECTIVES:
Thoracic Endovascular Aneurysm Repair (TEVAR) has become increasingly prevalent in the endovascular era. New advances promise a total endovascular solution for subclavian artery revascularization (SAR), but previous studies failed to analyze cost effectiveness in comparison to carotid-subclavian bypass or transposition (Open SAR) in conjunction with TEVAR. We analyzed hospital charge data to determine a potential price point.
METHODS:
We analyzed charge data for the room, OR and supplies. Supplies charges were adjusted for amount of TEVAR devices. We examined four different combinations of TEVAR and SAR with different methods. Groups were: 1) TEVAR + Open SAR in single operation;2) TEVAR + Open SAR at different admissions; 3) investigational single-branched TEVAR;and 4) TEVAR + Open SAR at separate OR visits but same hospitalization. We only examined room and OR charges for group 3 given that this device remains pre-market without a commercial price. We combined TEVAR charges with average Open SAR charges to calculate charges of both operations for group 2. We utilized analysis of variance and linear regression. All charges were inflation adjusted to 2010 dollars.
RESULTS:
Analysis of variance for each group and charge is shown in Table 1 with total OR charges found to be significant. For our regression model with group 2 as the reference, we found that OR charges were significantly lower for groups 1 and 3 compared to group 2 (Table 2)(p<0.001); however, groups 1 and 3 were not significantly different in terms of OR charges(p=0.23).
CONCLUSIONS:
Based on these findings it appears that the estimated cost is significantly lower when TEVAR and SAR are performed in the same setting. However, total room costs and supply costs per device do not appear significantly different noting that the majority of cost difference appears to be related to OR related costs. In order for a single-branched TEVAR to be cost effective in comparison to TEVAR + open SAR, the device must cost roughly the same price as a standard TEVAR device. 
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