Objective: Pulmonary embolism (PE) is a significant disease process that affects an estimated 117 cases per 100,000 person-years. Long-term complications are associated with acute PE; the most serious of these complications is chronic pulmonary hypertension, which has a significant cost to treat, ranging from US $98,000 to $117,000. This study evaluated catheter-directed thrombolysis (CDT) compared with systemic heparin administration in regard to patient outcomes, short-term cost, and long-term cost in a single center. The objective of this study was to compare systemic heparin administration and CDT and to evaluate whether there are advantages in expense or outcomes in one group over the other.Methods: A retrospective chart review was conducted of 341 patients who presented with massive or submassive PE and were treated with either systemic heparin therapy or CDT from January 2011 to November 2018. Total costs were determined as the sum of the hospital and professional bills, with long-term cost analysis using a standardized 100-patient model. The groups were then compared for initial and 5-year costs based on the data collected in the study, using chronic pulmonary hypertension rates and expenses determined from the study cohort.Results: Patient outcomes were significantly better for those treated with CDT, with fewer bleeding complications (4.2% vs 13.8%; P ¼ .005), a shorter length of stay (3.44 days vs 6.47 days; P < .001), a greater percentage of patients returning to their prior living conditions (89.0% vs 79.3%; P ¼ .042), and a lower rate of pulmonary hypertension at 12 months (6.3% vs 15.9%; P ¼ .030). The expense of initial admission was significantly higher in the CDT group compared with heparin, with a difference of approximately US $31,000 (P ¼ .001), although analysis showed the heparin group to have a higher cost over time. Analysis showed that the cost to treat a standardized group of 100 patients had an approximated difference of US $1.7 million when the total cost to treat is evaluated at the 5-year time point with a 3.2-year cost to recover.Conclusions: For patients with massive or submassive PE, this study demonstrated a significant long-term cost savings and improved outcomes for patients treated with CDT compared with systemic heparin administration.
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