Cost Analysis of Venous Stent Reconstruction in the Treatment of Chronic Lower Extremity Venous Occlusive Disease

Purpose: To quantify cost drivers of endovenous iliocaval stent reconstruction for chronic veno-occlusive disease based on time-driven activity-based costing. Materials and Methods: 31 iliocaval venous stent reconstruction procedures for iliocaval veno-occlusive disease were reviewed. Process model development began by constructing longitudinal process maps after interviews with representatives involved with iliocaval stent reconstructions. Subsequently, staff practical capacity rates and consumable equipment costs were analyzed using time-driven activity-based costing methods. Univariate and multivariate sensitivity analyses were conducted to identify the primary cost drivers of human labor and disposable materials.. Results: The mean procedure duration was 6.24 hours (5.75-7.15), and the base cost was $26,201.01. Multivariate sensitivity analyses yielded a cost range of $7,842.95 to $66,066.05. Using local salary information and negotiated prices for materials as parameters, the true base cost per case of iliocaval stent reconstruction was $25,750.33. Human personnel costs accounted for 16.8%, while disposable materials costs accounted for 83.2%. Univariate analysis demonstrated that the primary driver of human staffing costs was attending Anesthesiologist staffing time ($25,948.54 to $26,431.38). The predominant modifiable material cost drivers included the cost of venous stents ($17,801.01 to $34,811.01), their number ($19,326.01 to $29,326.01), the cost of catheters ($25,535.51 to $29,358.01), and their number ($24,961.01 to $27,441.01). Conclusion: Human labor, namely anesthesia staffing costs, and disposable material costs, namely stent and catheter selection, are large, potentially modifiable drivers of the overall cost for iliocaval stent reconstruction for chronic veno-occlusive disease. Additional studies are necessary to define an iliocaval venous reconstruction protocol that delivers cost savings without compromising outcomes.