OBJECTIVES

Repeat procedures or reintervention presents a potential economic burden when considering alternative approaches to femoropopliteal artery revascularization. This study estimated the cost of reintervention following femoropopliteal artery revascularization with stenting among Medicare beneficiaries.

METHODS

The 100% Medicare Standard Analytic Files were used to identify patients who underwent their first reintervention >90 days post-index femoropopliteal artery revascularization with stenting from 1/1/2016-6/31/2019. Reintervention was defined using Current Procedural Terminology codes for angioplasty with/without atherectomy and/or stenting, thrombectomy, thrombolysis, and bypass. Patients were followed from 90-days pre-reintervention through 90-days post-reintervention. This period was divided into 30-day intervals, with reintervention occurring on the first day of the fourth interval. The first two intervals were used to determine the patient’s baseline total cost to Medicare before reintervention. A within-patient “difference analysis” was performed by subtracting the average baseline costs from the costs in each of the four intervals. The four cost differences were summed to estimate the total cost of reintervention to Medicare. Adjusted comparison was conducted using ANOVA adjusting for patient baseline clinical and index procedure characteristics.

RESULTS

Of 93,146 adult patients with a femoropopliteal artery stent placement, 12,397(13.3%) had a reintervention >90 days (mean=353 days) post-index procedure. The mean age was 74.6 years, 53% were male, 87% were white, and 23% had critical limb ischemia (CLI). The total cost of reintervention to Medicare was $27,199 (95%CI $26,579, $27,819). For patients with CLI, the adjusted cost of reintervention was $29,047 versus non-CLI was $26,657 (cost differences=$2,390; 95%CI $1,793, $2,987).

CONCLUSIONS

Reintervention following femoropopliteal artery revascularization with stenting poses a substantial cost to Medicare. Given the high cost to Medicare, endovascular interventions that prevent reintervention would offer both clinical and economic benefits. There is a need for more cost-effectiveness studies on stenting reintervention.