Episode-based cost reduction for endovascular aneurysm repair

Abstract

Excessive costs associated with EVAR threaten the sustainability of these procedures in health care organizations. Targeted cost reduction efforts can effectively reduce expenses without compromising quality or limiting patients' access.

Perioperative Outcomes for Centers Routinely Admitting Postoperative Endovascular Aortic Aneurysm Repair to the ICU

“…8 The overall cost effectiveness becomes even more relevant when considering readmission and reinterventions. 5,8,9 Interventions and pathways have been established to help reduce costs. By focusing on implant, rooming, and imaging expenses, significant cost savings were achieved.…”

“…By focusing on implant, rooming, and imaging expenses, significant cost savings were achieved. 9 Some institutions have implemented same day discharges after EVAR, but a cost analysis was not performed. 4 Other institutions have implemented an EVAR fast-track discharge pathway to reduce cost and one study reported that fast-track EVARs, compared to standard EVAR discharge pathway, had a shorter total length of stay by .6 day that did not reach statistical significance.…”

“…1 In a value-based healthcare system, EVAR is a unique procedure as the high cost of the device accounts for almost half of the total hospital cost for the case, which could be balanced by other costs such as postoperative care. 1,[6][7][8][9] However, postoperative care for EVAR can easily lead to a negative contribution margin to a hospital in the absence of proper care pathways, poor industry and payer negotiations, and inefficient use of postoperative imaging and the ICU. 8,9 In addition, it is not clear whether the expense of routine ICU care after EVAR is justified by improved postoperative outcomes and, as such, reduction of postoperative ICU utilization may decrease healthcare costs without sacrificing the quality of care.…”

Proposed public policies to improve outcomes in vascular surgery: an experts’ forum

“…(43) Some studies report the reduction of expenses with stent grafts for aortic aneurysms by up to 30.8%, from the restructuring of contracts for the acquisition of materials, comparison of prices in the market, and transparency in negotiations with suppliers. (44) Thinking about strategies at a national level, stimuli such as tax incentives or the development of a structure that would allow national manufacturing may help reduce the costs of endovascular materials, allowing greater diffusion of these techniques.…”

Why should I join the Vascular Quality Initiative?

“…40 This pilot study provided all centers with more accurate and trusted cost benchmarking, due to the granular clinical data, and allowed Stanford surgeons to significantly reduce the costs of implants, bed utilization, inpatient imaging, and medications. 41 Ultimately, the combination of clinical outcomes with cost data allows calculation of value. One method to define quality is the avoidance of major adverse event rates, which can be adjusted for severity based on the associated, prolonged LOS.…”