Integration and added value of the modern noninvasive vascular laboratory in vascular diseases management.

Abstract

Today's vascular laboratory technology offers broad applications throughout vascular medicine. We explore the diagnostic work-up and management of selected peripheral vascular diseases by benchmarking the institutional mix of invasive and noninvasive technology utilization and associated cost burdens. Specialized diagnostic studies for prevention of stroke and pulmonary embolism, and diagnosis and management of femoral pseudoaneurysm were reviewed for our 355-physician clinic and hospital practice. The proportions and costs for invasive and noninvasive diagnostic procedures were tabulated for carotid stenosis, deep venous thrombosis (DVT), and iatrogenic femoral pseudoaneurysm. Current technology utilization mix cost burdens were compared to projected cost burdens for hypothetical equivalent medical value (i.e., the same total test volume) in the theoretical absence of noninvasive laboratory services. The technology utilization mix was dominated by noninvasive duplex ultrasonography for all 3 vascular disease workups. The technology utilization mix benchmarks were 92% noninvasive for carotid stenosis, 98% noninvasive for DVT, and 100% noninvasive for pseudoaneurysm. Under hypothetical constant test volume normalized to utilization level for the 2-year period, the maximal range in cost burdens between current reliance on noninvasive diagnoses versus projected 100% reliance on invasive procedures for the 3 vascular applications is approximately $6 million. Benchmark indices reveal near total adoption of noninvasive technology for vascular diagnostic workups at our center. The benefits to institutions of benchmarking their technology utilization mix and costs are discussed in relation to identifying potential for cost-containment from modifying technology utilization practices.