Presentation (CTI)

OBJECTIVES: Despite the clinical burden and risks associated with endovascular reintervention among patients with peripheral artery disease (PAD), data on the associated hospital costs remain limited. This study quantified the hospital costs of lower extremity (LE) endovascular reintervention using a large United States hospital database.
METHODS: A retrospective observational cost analysis was conducted from the hospital perspective using the Premier PINC AI™ Healthcare Database. Adults aged 18+ with a PAD diagnosis between January 1, 2017 and December 31, 2022 were identified. Eligible patients underwent an initial LE endovascular intervention (angioplasty, stent [including drug-coated, drug-eluting, and bare metal] placement, or atherectomy), followed by a subsequent LE endovascular intervention ≥6 months after discharge from the index encounter. Direct hospital costs for the endovascular reintervention encounter were assessed and inflation-adjusted to 2024 United States dollars. Subgroup analyses were performed by diabetes, chronic kidney disease (CKD), and chronic limb-threatening ischemia (CLTI), with comparisons conducted using two-sample t-tests and Mann-Whitney tests.
RESULTS: The cohort included 42,382 patients, with a mean (standard deviation [SD]) age of 65.7 (10.5) years and a mean (SD) Charlson Comorbidity Index score of 0.65 (1.36). The overall mean (SD) cost of the endovascular reintervention encounter from the hospital perspective was $20,808 ($23,938), and the median (interquartile range [IQR]) cost was $14,356 ($8,533-$24,904). Patients with diabetes, CKD, or CLTI had higher mean (+$3,652, +$5,203, +$4,091, respectively) and median (+$1,691, +$2,895, +$2,577, respectively) reintervention costs than patients without these conditions (all p<0.01).
CONCLUSIONS: Endovascular reintervention in PAD imposes substantial hospital costs, with average costs exceeding $20,000 per encounter and significantly higher among patients with diabetes, CKD, and CLTI. These findings underscore the economic burden of repeat interventions and the potential value of strategies that reduce reintervention risk (e.g., durable endovascular therapies and optimized medical management).