OBJECTIVES

Inferior vena cava filters (IVCFs) are placed in patients with acute venous thromboembolism (VTE) to prevent pulmonary embolism (PE) when there is a contraindication to or failure of anticoagulation. Studies examining the costs of IVCF placement among VTE beneficiaries are lacking. This study quantified the costs incurred to Medicare for the index IVCF placement in VTE beneficiaries.

METHODS

A retrospective analysis of the 100% Medicare Standard Analytic Files (1/1/2014-12/31/2019) identified newly diagnosed VTE patients with 12-months continuous Medicare enrollment pre-index VTE date and without prior IVCF placement. VTE patients were followed for 12-months after their index VTE diagnosis until their index IVCF placement, end of Medicare coverage, or death. The mean cost associated with the index IVCF placement was estimated and examined by VTE type (deep venous thrombosis [DVT]), PE, and DVT/PE) and service location (inpatient and outpatient).

RESULTS

Among 194,016 Medicare beneficiaries with newly diagnosed VTE, 2,118 (1.1%) had an IVCF placed. The mean time from the VTE diagnosis to the index IVCF placement was 56 days (SD 86.2). The average age was 76 years; 89.8% were white while 56.2% were females. Of these patients, 56.7% had DVT, 25.5% had PE, 17.9% had DVT/PE, and 82.0% had their index IVCF placed at an outpatient setting. The mean cost of the overall IVCF placement was $4,844.34 (95%CI $4,348.07, $5,340.61). The mean index IVCF placement costs by VTE type were: DVT: $4,649.45 (SD $10,185.90), PE: $4,744.33 (SD $14,349.40), and DVT/PE: $5,605.17 (SD $11,444.22) (p=0.3699). The mean total cost was $23,011.13 (SD $38,499.29) for inpatient versus outpatient setting $2,860.43 (SD $1,391.38) (p< 0.0001).

CONCLUSIONS :

In newly diagnosed VTE Medicare beneficiaries, costs incurred for the index IVCF placement in the inpatient setting were significantly higher than in the outpatient setting. Future research is needed to explore the drivers of the cost differences by service location.