Modelling Costs of Interventional Pulmonary Embolism Treatment: Implications of US Trends for a European Healthcare System

Katharina Mohr; Brent Keeling; Klaus Kaier; Thomas Neusius; Rachel P Rosovsky; John M Moriarty; Kenneth Rosenfield; Christina Abele; Ioannis T Farmakis; Karsten Keller; Stefano Barco; Richard N Channick; Jay S Giri; Robert A Lookstein; Thomas M Todoran; Konstantinos C Christodoulou; Lukas Hobohm; Michelle Lanno; Jamie Reed; Harald Binder; Stavros V Konstantinides; Luca Valerio; Eric A Secemsky

doi:10.1093/ehjacc/zuae019

Modelling Costs of Interventional Pulmonary Embolism Treatment: Implications of US Trends for a European Healthcare System

Eur Heart J Acute Cardiovasc Care. 2024 Feb 13:zuae019. doi: 10.1093/ehjacc/zuae019. Online ahead of print.

Authors

Katharina Mohr^{1

2}, Brent Keeling³, Klaus Kaier², Thomas Neusius⁴, Rachel P Rosovsky⁵, John M Moriarty⁶, Kenneth Rosenfield⁷, Christina Abele^{1

8}, Ioannis T Farmakis^{1

9}, Karsten Keller^{1

9

10}, Stefano Barco^{1

11}, Richard N Channick¹², Jay S Giri¹³, Robert A Lookstein¹⁴, Thomas M Todoran¹⁵, Konstantinos C Christodoulou¹, Lukas Hobohm^{1

9}, Michelle Lanno¹⁶, Jamie Reed¹⁶, Harald Binder², Stavros V Konstantinides^{1

17}, Luca Valerio¹, Eric A Secemsky¹⁸

Affiliations

¹ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
² Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
³ Emory University School of Medicine, Atlanta, GA, USA.
⁴ Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany.
⁵ Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of Interventional Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁷ Massachusetts General Hospital, Boston, MA, USA.
⁸ School of Life Sciences, University of Siegen, Germany.
⁹ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
¹⁰ Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
¹¹ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
¹² Pulmonary and Critical Care Division, David Geffen School of Medicine, Los Angeles, California, USA.
¹³ Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁵ Medical University of South Carolina, Charleston, SC, USA.
¹⁶ The PERT Consortium™, Nashua, NH, USA.
¹⁷ Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
¹⁸ Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

PMID: 38349225
DOI: 10.1093/ehjacc/zuae019

Abstract

Background: Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is entering a growth phase in Europe following a steady increase in the United States (US) in the past decade, but the potential economic impact on European healthcare systems remains unknown.

Methods and results: We built two statistical models for the monthly trend of proportion of CDT among patients with severe (intermediate- or high-risk) PE in the US. The conservative model was based on admission data from the National Inpatient Sample (NIS) 2016-2020, and the model reflecting increasing access to advanced treatment from the PERTTM national quality assurance database registry 2018-2021. By applying these models to the forecast of annual PE-related hospitalizations in Germany, we calculated the annual number of severe PE cases and the expected increase in CDT use for the period 2025-2030. The NIS-based model yielded a slow increase, reaching 3.1% (95% CI 3.0-3.2%) among all hospitalizations with PE in 2030; in the PERT-based model, increase would be steeper, reaching 8.7% (8.3-9.2%). Based on current reimbursement rates, we estimated an increase of annual costs for PE-related hospitalizations in Germany ranging from 15.3 to 49.8 million euros by 2030. This calculation does not account for potential cost savings, including those from reduced length of hospital stay.

Conclusion: Our approach and results, which may be adapted to other European healthcare systems, provide a benchmark for healthcare costs expected to result from CDT. Data from ongoing trials on clinical benefits and cost savings are needed to determine cost-effectiveness and inform reimbursement decisions.

Keywords: Pulmonary embolism; catheter-directed treatment; cost of illness; economic impact; hospitalization costs.