Systematic Review and Update on Economic Research in Interventional Radiology

Wednesday, March 8, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Muhammad Saad Malik, MD

Post-doctoral Research Fellow
Beth Israel Deaconess Medical Center | Harvard Medical School

Disclosure information not submitted.

Author/Co-author(s)

Julie C. Bulman, MD

Interventional Radiologist
Beth Israel Deaconess Medical Center, Harvard Medical School
Will S. Lindquester, MD

Independent IR Resident
Emory University School of Medicine
MH

Matthew Hawkins, MD

Associate Professor
Emory University School of Medicine, Children's Healthcare of Atlanta
Raymond Liu, MD, FSIR

Professor
MGH
Ammar Sarwar, MD FSIR (he/him/his)

Associate Professor of Radiology
Beth Israel Deaconess Medical Center

Disclosure(s):

Julie C. Bulman, MD: Argon Medical Devices: Consultant (Ongoing)

Will S. Lindquester, MD: No financial relationships to disclose

Raymond Liu, MD, FSIR: No financial relationships to disclose

Ammar Sarwar, MD FSIR: Agile Devices, Inc.: Advisory Committee or Review Panel Member (Ongoing)

Purpose:

To provide an update on cost-based research in interventional radiology (IR) following the 2017 Research Consensus Panel.

Materials and Methods:

A retrospective assessment of global data from 2017 till present day was conducted on cost-effectiveness (CE) research in adult and pediatric IR. All cost-methodologies, services lines, and IR treatment modalities were screened to identify preliminary key domains including types of comparison (between IR devices, between IR and non-IR devices) and cost-analytical processes (ICER, QALY, TDABC) used. Primary outcome was evaluating the CE of IR therapies based on stakeholder perspectives. Analyses were reported in a standardized fashion to include types of service lines, comparators, cost analytical processes, databases, and cost variables used.

Results:

62 studies were included, with majority from the U.S. (60%). The majority of studies (61%) were cost-comparative. ICER, QALY and TDABC were reported in 46%, 45%, and 10%, respectively. Most reported service lines were aortic/PAD (16%) and Interventional Oncology (16%). No studies reported on VTE, portal vasculature, biliary or endocrine therapies. Cost reporting was heterogeneous owing to cost variables included, databases used, time horizons assessed, and WTP thresholds. IR therapies were more CE than their non-IR counterparts in HCC ($55925 vs $211286), renal tumors ($12435 vs $19399), PAD (€29058 vs €42437), AAA (€5776 vs €7101), BPH ($6464 vs $9221), fibroids ($3772 vs $6318), SAH ($1923 vs $4343), stroke ($551159 vs $577181), and plastic bronchitis ($340941 vs $594520), among others. TDABCs were subjectively informative for single episodes of care but not for long term comprehensive care. TDABCs identified that modifiable factors like disposables and materials were dominant drivers of IR costs: thoracic duct embolization (68%), ablation (42%), TACE (30%), TARE (80%), AVMs (75%) and VMs (45%), and bone palliation (41%). This made IR therapies more CE in countries with high WTP thresholds (US) but not in those with low GDP rates. Moreover, access and usage of IR was still globally limited e.g., hysterectomy (83.9%) vs uterine sparing treatments (75.3%). Future steps include tailoring WTP thresholds to nation and health systems, cost-effective pricing for disposables, standardizing cost sourcing methodology.

Conclusion:

Despite advancements in cost-analysis and IR demonstrating CE, gaps remain in certain service lines, standardization in research methodology, and improving access and usage of IR.