Cost Analysis of Intravascular Ultrasound Guidance for Transjugular Intrahepatic Portosystemic Shunt Creation.

PURPOSE: To compare costs of intravascular ultrasound (IVUS)-guided transjugular intrahepatic portosystemic shunt (TIPS) creation versus non-IVUS-guided TIPS creation, accounting for differences in procedure time and resource utilization. MATERIALS AND METHODS: This single-institution retrospective study estimated procedure time and resource utilization from 157 consecutive elective TIPS creation procedures, of which 91 were IVUS-guided and 66 were non-IVUS-guided. Differences in procedure costs were derived using time-driven activity-based costing. The difference in post-TIPS creation length of hospital stay was included in overall episode of care cost estimates. RESULTS: IVUS-guided TIPS creation was 45.5 minutes faster (P < .001) and required 35.2 mL less contrast medium (P < .001), leading to savings of $325.34 on staffing, $58.21 on medications, and $76.59 on equipment usage. However, requiring $2,100 single-use disposable catheters, IVUS guidance was $1,484.96 more costly per procedure. Following TIPS creation, the mean length of hospital stay was 1.3 days after IVUS-guided procedures versus 2.1 days after non-IVUS-guided procedures (P = .001). With an estimated cost of $2,677 per hospital day, there was an overall savings of $656.64 with IVUS-guided TIPS creation. CONCLUSIONS: Improved procedural metrics during TIPS creation alone are unlikely to offset the costs of IVUS guidance. However, based on improvements in immediate post-TIPS creation clinical outcomes, which may translate into shorter hospitalization, IVUS guidance is likely to reduce overall costs for the episode of care related to TIPS creation.

Duke Scholars

Author Waleska Michelle Pabon-Ramos Radiology, Interventional Radiology

Author Neil Deep Ray Anesthesiology, Regional

Author James Spencer Ronald Radiology

Author Charles Yoon Kim Radiology, Interventional Radiology

Author Jonathan Martin Radiology, Interventional Radiology