OBJECTIVES : Reintervention is an important determinant of the overall cost-effectiveness of alternative approaches to femoropopliteal artery revascularization. This study estimated the total cost to Medicare of reintervention in a real-world cohort of Medicare patients.

METHODS : Medicare claims and administrative data were used to identify patients who (A) underwent their first observed femoropopliteal artery revascularization with stenting (index procedure) in 2016-2017, and (B) subsequently underwent their first reintervention procedure >90 days after the index procedure. Reintervention procedures, consisting of angioplasty with or without atherectomy and/or stenting, thrombectomy, thrombolysis, or bypass, were identified using Current Procedural Terminology codes in the claims. Patients were followed from 90 days before, to up to 90 days after, their first reintervention (observation period). The observation period was divided into 30-day intervals such that the reintervention procedure occurred on the first day of the fourth interval. The first two intervals were used to establish a patient’s baseline total cost prior to reintervention. A within-patient “difference analysis” was conducted in which the average cost in the first two intervals was subtracted from the costs in each of the following four intervals.

RESULTS : There were 571 patients who had a reintervention at least 90 days (mean = 249 days) after their index procedure. The average age was 71 years, 56.7% were male, and 62.9% had critical limb ischemia (CLI). Overall, the estimated total cost of reintervention was $20,638 (95% confidence Interval [CI] $17,829-$23,447). The adjusted (for patient baseline clinical/procedural characteristics) cost was $22,490 for patients with CLI compared to $17,502 for those without (difference = $4,987; 95% CI -$1,557 - $11,532).

CONCLUSIONS : The cost to Medicare of reintervention following femoropopliteal artery revascularization with stenting is substantial. Treatment modalities, such as drug-eluting stents, that significantly reduce the risk of reintervention are likely also to result in substantial cost offsets.