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Peripheral vascular intervention use stabilized in recent years
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The rate of growth in use of peripheral vascular interventions appears to have stabilized from 2006 to 2011, but a new report suggests the clinical setting where these procedures are performed is shifting and highlights increasing use of atherectomy compared with other modalities.
Researchers assessed a 5% national sample of Medicare fee-for-service beneficiaries (n = 39,339) who underwent revascularization for peripheral arterial disease from 2006 to 2011. Of those, 27.3% underwent peripheral vascular intervention, 27.3% angioplasty alone, 22.4% atherectomy and 50.3% stent implantation with or without angioplasty.
From 2006 to 2011, the annual rate of peripheral vascular intervention increased minimally from 401.4 per 100,000 Medicare beneficiaries to 419.6 per 100,000 Medicare beneficiaries (P = .17), surgical revascularization procedures decreased from 115.5 per 100,000 to 77.8 per 100,000 (P = .02) and hybrid revascularization procedures increased slightly from 8.8 per 100,000 to 11 per 100,000 (P = .03). The researchers reported a rise in the use of peripheral vascular intervention with angioplasty alone (97.7 per 100,000 to 109.4 per 100,000; P = .07) and atherectomy (96.4 per 100,000 to 125.9 per 100,000; P = .38), but a modest decline in use of stents (207.4 per 100,000 to 184.3 per 100,000; P = .44).
The rate of peripheral vascular interventions in inpatient settings decreased from 209.7 per 100,000 Medicare beneficiaries in 2006 to 151.6 per 100,000 Medicare beneficiaries in 2011 (P < .001). However, the rate of peripheral vascular interventions performed in outpatient hospitals (184.7 per 100,000 to 228.5 per 100,000; P = .01) and office-based clinics (6 per 100,000 to 37.8 per 100,000; P = .008) rose significantly during the study period.
Atherectomy use increased twofold in outpatient settings and 50-fold in office-based clinics from 2006 to 2011.
All types of peripheral vascular interventions yielded similar average costs. However, use of atherectomy in the outpatient and office-based clinic settings was more expensive compared with stenting and angioplasty alone. In 2011, the mean cost of atherectomy was $13,478 in office-based clinics and $8,680 in the outpatient setting. In contrast, in the office-based setting, the mean cost of stenting was $6,379 and angioplasty was $4,800.
Surgeons and cardiologists performed most peripheral vascular interventions. The use of peripheral vascular interventions by surgeons increased from 140.1 per 100,000 in 2006 to 177.5 per 100,000 in 2011 and use by cardiologists increased from 154.9 per 100,000 to 166.9 per 100,000. The data demonstrated a steady decline in peripheral vascular interventions performed by radiologists during the study period.
“Studies in the late 1990s and early 2000s reported a sharp rise in both the numbers and the overall costs of peripheral vascular intervention, with a majority of the costs attributable to procedures performed in inpatient hospital settings. Accordingly, U.S. Centers for Medicare & Medicaid Services implemented changes in the outpatient prospective payment system (OPPS) in 2008 that led to the establishment of ‘ambulatory payment classifications’ and bundling of payments for peripheral vascular interventions in outpatient facilities and office-based clinics.
“… The current study sheds light on possible unintended consequences of these payment decisions and highlights the need for further clinical studies to demonstrate the effectiveness and value of device technologies such as atherectomy,” the researchers wrote. – by Rob Volansky
Disclosures: The researchers report associations with companies including Amgen, AstraZeneca, Baxter, Bayer AG, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutical Products, Johnson & Johnson, Merck, Novartis, Ortho-McNeil-Janssen, Pluristem and Sanofi.
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