SIR 2024
Gastrointestinal Interventions
Ali Husnain, MD (he/him/his)
Research Specialist
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Harjit Singh, MD, FSIR
Professor of Radiology and Radiological Science
Johns Hopkins Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Michael Cangelosi, MA, MPH
Associate Director and Prinicipal Health Economist
Boston Scientific
Disclosure information not submitted.
Medicare patients ( >18 years old) with at least one PTBD exchange between 1/1/2016 and 11/30/2022 were identified using the 100% Medicare Standard Analytic Files. The index date was defined as that of the first PTBD exchange. Patients were followed from 6 months pre-index until PTBD removal, loss of continuous enrollment, or death. Outcomes include patient pathway after each exchange, duration between successive exchanges, and direct costs (including outpatient hospital and inpatient service costs, but not outpatient prescription drug costs) borne by the hospital and patients.
Results: We identified 24,714 patients with at least one PTBD exchange (mean age of 72.5 years, 54.0% men,79.0% white). The percentage of patients requiring additional exchange increases with the number of prior exchanges – from 45.3% for the second exchange to 82.5% for the ninth exchange. More than 80% of patients had exchanges within 90 days, though duration between exchanges increased with more exchanges. Only 14.8% of patients had a claim of PTBD catheter removal. Patients with 1-2 exchanges had a mean (median) exchange-related hospital cost of $19,066 ($3,398); that increased to $32,972 ($16,141) for patients with ≥3 exchanges. Similarly, the mean (median; 75th percentile) patient out-of-pocket costs for PTBD exchanges increased from $657 ($0; $0) for patients with 1-2 exchanges to $802 ($0; $758) for those with ≥3 exchanges.
Conclusion: PTBD removal rates are less than 15%. Patients requiring multiple PTBD exchanges are likely to have a high clinical and economic burden over their lifetime. The IR community should consider adopting innovative endo-biliary technologies with the potential to decrease the lifetime duration of these drains.