Comparison of Success and Cost Following Retrieval of Two Inferior Vena Cava Filters

BackgroundTo compare outcomes and costs of retrieval of two commonly used inferior vena cava (IVC) filters.MethodsA retrospective review of all patients who underwent retrieval/attempted retrieval of IVC filter at a university affiliated tertiary care center during a 5-year period was completed. Demographics, comorbidities, filter brand, retrieval procedural data, filter retrieval cost and complications were recorded and compared the higher (Denali) and lower priced (Option) filters.ResultsRetrieval was attempted in 57 Denali and 44 Option IVC filters with secondary procedures attempted in 0% Denali vs 4.5% Option (P = .44). No significant differences between filter type (Denali vs Option) were noted for male gender (52.6% vs 47.7%; P = .63), mean age at retrieval (60 ± 15 years vs 59 ± 15 years; P = .78) or indication for placement: (deep vein thrombosis + pulmonary embolism + contraindication to anticoagulation: 38.6% vs 54.5%; P = .15). Comorbidities were similar. Denali filters were less likely to have significant tilt of greater than 5° (14.0% vs 38.6%) or have the hook embedded in the IVC wall (0% vs 11.4%; P < .001). Device fracture (1.8% vs 0%) was similar (P = .38). Months to retrieval was 12.4 for Denali vs 11.2 for Option (P = .75). The Bard retrieval device was used in 89.5% of Denali and 71.7% of Option (P = .09). Denali was more likely to be successfully retrieved on first attempt (94.7% vs79.5%; P = .019), with similar overall success following secondary attempts (94.7% vs 81.8%; P = .056). Need for adjunctive procedures was similar (0% vs 8.7%; P = .08), as were procedure-related complications (0% vs 4.3%; P = .08). Denali had shorter fluoroscopy time (7.4 minutes vs 22.2 minutes; P = .001), procedural time (32.0 minutes vs 60.7 minutes; P < .001), total hospital costs ($3154 vs $5245; P < .001), and procedure costs ($1333 vs $1985; P < .001). When secondary retrieval attempts were included, hospital costs (distributed across all Option retrievals) increased to $5981 and procedural costs to $2098. The average price of the Denali filter is $1675 versus $850 for Option.ConclusionsAlthough the price of the Denali IVC filter is nearly double that of Option, tilting or hooking occurred significantly less often with Denali. These factors which make retrieval more difficult resulted in shorter procedure and fluoroscopic times with Denali and ultimately in lower retrieval costs, offsetting the initial expense of the filter. BackgroundTo compare outcomes and costs of retrieval of two commonly used inferior vena cava (IVC) filters. To compare outcomes and costs of retrieval of two commonly used inferior vena cava (IVC) filters. MethodsA retrospective review of all patients who underwent retrieval/attempted retrieval of IVC filter at a university affiliated tertiary care center during a 5-year period was completed. Demographics, comorbidities, filter brand, retrieval procedural data, filter retrieval cost and complications were recorded and compared the higher (Denali) and lower priced (Option) filters. A retrospective review of all patients who underwent retrieval/attempted retrieval of IVC filter at a university affiliated tertiary care center during a 5-year period was completed. Demographics, comorbidities, filter brand, retrieval procedural data, filter retrieval cost and complications were recorded and compared the higher (Denali) and lower priced (Option) filters. ResultsRetrieval was attempted in 57 Denali and 44 Option IVC filters with secondary procedures attempted in 0% Denali vs 4.5% Option (P = .44). No significant differences between filter type (Denali vs Option) were noted for male gender (52.6% vs 47.7%; P = .63), mean age at retrieval (60 ± 15 years vs 59 ± 15 years; P = .78) or indication for placement: (deep vein thrombosis + pulmonary embolism + contraindication to anticoagulation: 38.6% vs 54.5%; P = .15). Comorbidities were similar. Denali filters were less likely to have significant tilt of greater than 5° (14.0% vs 38.6%) or have the hook embedded in the IVC wall (0% vs 11.4%; P < .001). Device fracture (1.8% vs 0%) was similar (P = .38). Months to retrieval was 12.4 for Denali vs 11.2 for Option (P = .75). The Bard retrieval device was used in 89.5% of Denali and 71.7% of Option (P = .09). Denali was more likely to be successfully retrieved on first attempt (94.7% vs79.5%; P = .019), with similar overall success following secondary attempts (94.7% vs 81.8%; P = .056). Need for adjunctive procedures was similar (0% vs 8.7%; P = .08), as were procedure-related complications (0% vs 4.3%; P = .08). Denali had shorter fluoroscopy time (7.4 minutes vs 22.2 minutes; P = .001), procedural time (32.0 minutes vs 60.7 minutes; P < .001), total hospital costs ($3154 vs $5245; P < .001), and procedure costs ($1333 vs $1985; P < .001). When secondary retrieval attempts were included, hospital costs (distributed across all Option retrievals) increased to $5981 and procedural costs to $2098. The average price of the Denali filter is $1675 versus $850 for Option. Retrieval was attempted in 57 Denali and 44 Option IVC filters with secondary procedures attempted in 0% Denali vs 4.5% Option (P = .44). No significant differences between filter type (Denali vs Option) were noted for male gender (52.6% vs 47.7%; P = .63), mean age at retrieval (60 ± 15 years vs 59 ± 15 years; P = .78) or indication for placement: (deep vein thrombosis + pulmonary embolism + contraindication to anticoagulation: 38.6% vs 54.5%; P = .15). Comorbidities were similar. Denali filters were less likely to have significant tilt of greater than 5° (14.0% vs 38.6%) or have the hook embedded in the IVC wall (0% vs 11.4%; P < .001). Device fracture (1.8% vs 0%) was similar (P = .38). Months to retrieval was 12.4 for Denali vs 11.2 for Option (P = .75). The Bard retrieval device was used in 89.5% of Denali and 71.7% of Option (P = .09). Denali was more likely to be successfully retrieved on first attempt (94.7% vs79.5%; P = .019), with similar overall success following secondary attempts (94.7% vs 81.8%; P = .056). Need for adjunctive procedures was similar (0% vs 8.7%; P = .08), as were procedure-related complications (0% vs 4.3%; P = .08). Denali had shorter fluoroscopy time (7.4 minutes vs 22.2 minutes; P = .001), procedural time (32.0 minutes vs 60.7 minutes; P < .001), total hospital costs ($3154 vs $5245; P < .001), and procedure costs ($1333 vs $1985; P < .001). When secondary retrieval attempts were included, hospital costs (distributed across all Option retrievals) increased to $5981 and procedural costs to $2098. The average price of the Denali filter is $1675 versus $850 for Option. ConclusionsAlthough the price of the Denali IVC filter is nearly double that of Option, tilting or hooking occurred significantly less often with Denali. These factors which make retrieval more difficult resulted in shorter procedure and fluoroscopic times with Denali and ultimately in lower retrieval costs, offsetting the initial expense of the filter. Although the price of the Denali IVC filter is nearly double that of Option, tilting or hooking occurred significantly less often with Denali. These factors which make retrieval more difficult resulted in shorter procedure and fluoroscopic times with Denali and ultimately in lower retrieval costs, offsetting the initial expense of the filter.