Jennifer LaRoy BA, Presenter: Nothing to Disclose

Thejus Jaykrishnan, Abstract Co-Author: Nothing to Disclose

Sarah Beth White MD, Abstract Co-Author: Consultant, Guerbet SA Consultant, Vascular Solutions, Inc Research support, Seimens AG

Stephanie Dybul, Abstract Co-Author: Nothing to Disclose

Thomas Duris, Abstract Co-Author: Nothing to Disclose

Dirk Ungerer, Abstract Co-Author: Nothing to Disclose

Kiran Turaga, Abstract Co-Author: Nothing to Disclose

Parag J. Patel MD, Abstract Co-Author: Consultant, Medtronic, Inc Consultant, C. R. Bard, Inc Consultant, Cook Group Incorporated Speakers Bureau, Medtronic, Inc Consultant, Penumbra, Inc

In the face of changing health care reimbursements toward bundled care, the issue of minimizing cost is pertinent. While there has been a 20,510% increase in the number of chest ports (CP) placed by interventional radiologists from 1992-2011, surgery continues to dominate in placement of long term central venous access devices. This study compares the cost of CP insertions performed by interventional radiology (IR) vs. surgical implantation (OR) at a single institution.

Cost data on 100 IR and 49 OR consecutive Medicare outpatients that had isolated chest port insertions between 3/2012-2/2013 was obtained for both the operative services (IR suite vs OR) and pharmacy. The costs incurred by the hospital were divided into variable labor, supplies, room, and fixed costs for each case. Each cost was summarized as mean and standard deviation. Non-parametric tests for heterogeneity were performed using Kruskal-wallis method. Alpha was fixed at 0.05 for statistical significance.

Overall mean charges to place a CP were significantly higher in the OR, both in room and pharmacy costs (p < 0.0001). The overall average cost to place chest ports in an OR setting was almost twice that of placement in the IR suite. There was not a single identifiable cause for this difference. Rather, every category of cost (labor, supply, variable and fixed room cost) was higher in the OR (see Figure 1). Furthermore, the costs in each category varied minimally between IR cases but demonstrated a much greater variance between OR cases. This pattern also holds true for pharmacy costs. Again, the pharmacy costs were greater and varied more for OR cases in every cost category except for pharmacy labor.

Cost incurred to the hospital demonstrated significant differences between surgeons and interventional radiologists. Given that our prior work shows that complication rates in CP insertions in these two services are similar,1 it can be concluded that IR services are more cost effective for chest port insertion.  1 LaRoy J, et al. Morbidity Analysis of Chest Port Insertion: Interventional Radiology vs. Surgical Placement. J Vasc Interv Radiol 2014;25(3S):S100.

Our findings suggest that there is a significantly lower cost associated with chest port placement performed in the IR suite.   

LaRoy, J, Jaykrishnan, T, White, S, Dybul, S, Duris, T, Ungerer, D, Turaga, K, Patel, P, Cost Analysis of Chest Port Insertion: Interventional Radiology vs. Surgical Placement.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006171.html