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SIR 2025

Portal Hypertension

Traditional Poster

Session: Traditional Poster Presentations

104 - Cost comparison of intravascular ultrasound-guided versus non-intravascular ultrasound-guided transjugular intrahepatic portosystemic shunt creation

Monday, March 31, 2025
12:10 PM – 1:10 PM CT
Location: Music City Center, Expo Poster Area
Purpose:

Use of side-firing phased-array sectoral intravascular ultrasound (IVUS, alternatively intracardiac echocardiography or ICE) during transjugular intrahepatic portosystemic shunt (TIPS) creation is associated with fewer needle passes, shorter procedure times, and potentially reduced complications. However, IVUS introduces additional equipment costs. Time-driven activity-based costing (TDABC) provides a granular, bottom-up methodology to compare expected cost of care between IVUS-guided and non-IVUS-guided TIPS procedures. This work analyzed the procedure and hospitalization cost differences between IVUS-guided and non-IVUS-guided elective TIPS creation.

Materials and Methods:

Consecutive TIPS totaling 91 IVUS-guided procedures from 2014-2022 were retrospectively compared to 66 non-IVUS-guided procedures at a single hospital. Procedural and post-procedural metrics were collected for each patient, including procedural time and length of hospital stay. TDABC was used to estimate differential costs between IVUS-guided and non-IVUS guided procedures, and total hospitalization costs were based on national Kaiser Family Foundation estimates.

Results:

Although IVUS-guided TIPS procedures were 45.5 minutes shorter (p < 0.001), this time savings only partially offset the upfront cost of the IVUS catheter ($2100) resulting in $1452 greater cost per procedure. Sensitivity analysis suggested that single-use catheter cost ($819 to $3192) increased procedure costs ($171 to $2544) whereas catheter resterilization ($235 per reuse) decreased cost ($413 savings). However, shorter hospitalization in IVUS-guided TIPS patients (1.3 days versus 2.1 days in non-IVUS-guided TIPS, p < 0.001) resulted in an estimated $2142 cost reduction for IVUS-guided TIPS for an overall savings of $689 even with single-use catheters.

Conclusion:

Despite upfront incremental equipment costs, IVUS catheter use during TIPS creation results in cost savings when accounting for decreased length of hospital stay. These findings may support physician-led initiatives for IVUS catheter investments in resource-constrained practices, as well as guide reimbursement policy to incentivize cost-effective care.