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Reimbursement of Long-Term Post Placement Costs After Endovascular Abdominal Aortic Aneurysm Repair

Jason K. Kim¹, Robert E. Noll, Jr.¹, Britt H. Tonnessen¹, W. Charles A. Sternbergh, III¹, Samuel R. Money.^2
1Ochsner Clinic Foundation, New Orleans, La.;²Mayo Clinic Scottsdale, Scottsdale, Ariz.

OBJECTIVES: Post-placement cost of surveillance and secondary procedures over 5 years increases the global cost of endovascular aortic aneurysm repair (EVAR) by nearly 50%. This study identified and assessed the reimbursement received for long-term post-placement costs after EVAR.

METHODS: Between December 1998 and June 2007, 310 patients underwent EVAR at a single institution. The hospital and professional reimbursement collected from charges of post-placement surveillance, secondary interventions or aneurysm-related re-admissions was compared against the actual costs. All amounts were converted to year 2007 dollars. To minimize costs associated with the early learning curve, the initial 50 EVAR patients between December 1995 and 1998 were excluded. Patients with <1 year follow-up were also excluded. Data are expressed as mean±S.E.

RESULTS: The mean follow-up after EVAR for 152 patients was 38.8±1.8 months. The cumulative 5-year post-placement reimbursement received per patient was $9,792 for a cost of $12,027, an average loss of $2,235 per patient. Medicare, capitated insurance, and commercial insurance provided coverage for 85 (55.9%), 49 (32.0%), and 18 (11.8%) patients, respectively. The average reimbursement rate over the 5 year period was 35.8%±0.6%. The lowest reimbursement rate was seen in patients with Medicare at 31.6%±0.7% (p<.05). When fractionated, the 5-year cumulative reimbursement received from Medicare, capitated insurance, and commercial insurance was $9,473, $8,531, and $17,153, respectively. The 29 (19.1%) patients with secondary interventions had a 5-year cumulative cost per patient of $33,314 with a cumulative reimbursement of $23,936 per patient. The 123 (80.9%) patients without secondary interventions had a 5-year cumulative cost of $4021 per patient with a cumulative reimbursement of $5,851. The differences between 5-year cumulative costs, rate of secondary interventions, and number of secondary interventions per patient between the three payors were not statistically significant (p>.05).

CONCLUSIONS: Current reimbursement is not sufficient to meet the costs associated with long-term surveillance and needed secondary procedures after EVAR. Inadequate reimbursement of costs of secondary procedures was the primary driver for the net institutional loss.

AUTHOR DISCLOSURES: J.K. Kim, None; R.E. Noll, None; B.H. Tonnessen, None; W.C.A. Sternbergh, None; S.R. Money, None.