Supply Costs in Complex and Routine Inferior Vena Cava Filter Retrieval (IVCFR) – Ten Years’ Data from a Single Center

To characterize the medical supply costs associated with complex IVCFR using endobronchial forceps (EF) and routine IVCFR using a snare or Recovery Cone (RC).

Materials and Methods:

An IRB-approved retrospective review identified 845 attempted IVCFRs at a tertiary referral center from October 1, 2012 to June 20, 2022. To permit direct cost comparisons, transfemoral retrievals, retrievals of filters found fractured on pre-procedure spot imaging and retrievals concurrent with other billable procedures were excluded. The remaining 594 retrievals were categorized by initial retrieval strategy, generally informed by rotational cavography: EF (n = 312) for tilted or tip-/strut-embedded filters and a snare (n = 255; Günther Tulip: 235, Clover: 12, Dual Sheath: 4, ONE: 3, Gooseneck: 1) or RC (n = 27) for well-positioned filters with and mostly without hooks, respectively. List prices of 129 unique supplies at time of retrieval were obtained or, rarely, estimated. Per-retrieval EF prices were calculated by dividing EF list prices by ~22.5, an estimate of average EF uses. Prices of supplies relevant per retrieval were summed and normalized to first-half 2022 dollars using standard CPI. Contrast use, fluoroscopic time, filter type, dwell time and patient age and sex were recorded. Mean between-group cost differences were estimated by linear regression, adjusting for date-group interaction.

Results:

Of the 594 IVCFRs considered, 591 were successful: 2 EF and 1 snare retrieval failed; 4 EF retrievals were successful with a snare and 2 with smaller EF, 12 snare retrievals were successful only with EF, 1 RC retrieval only with a snare and 2 only with EF. Multivariable model indicated significantly lower mean cost of EF ($564.70 ± 9.75) compared to snare ($811.29 ± 10.83, p < .0001) and RC ($1465.48 ± 47.12, p < .0001) retrievals. Results were consistent when adjusting for dwell time and filter type, as well as in stratified sensitivity analysis for before and after May 2016, when one (usually 16Fr) instead of two (usually 14 and 12Fr) sheaths became standard for all EF retrievals. Had all retrievals been attempted with EF, estimated undiscounted full-period supplies savings would be $87,201.51. Table shows full-period endpoint data.

Conclusion:

EF are affordable for complex IVCFR; extending their use to routine IVCFR could create considerable cost savings.