PC174. 15-Year Impact of Consensus Statements and Reimbursement on Vena Cava Filter Utilization

Abstract

Pulmonary embolism (PE) is the third most common cause of death in hospitalized patients. Vena cava filters (VCFs) may be used as PE prophylaxis, particularly in patients with venous thromboembolism (VTE) or risk factors for deep vein thrombosis (DVT) who have contraindications to anticoagulation. However, the indication for VCFs has changed over the past 15 years as a result of practice guidelines and reimbursement rates. The aim of this study was to evaluate the impact of practice guidelines and reimbursement on national trends in VCF placement from 1998 to 2012. The National Inpatient Sample (NIS) was used to identify patients who underwent VCF placement between 1998 and 2012. Patient demographics, indications for placement, and outcomes were evaluated. Practice guidelines and consensus statements were identified using a PubMed search. Reimbursement rates for VCF were determined based on published Medicare reports. Statistical analysis were completed using descriptive statistics, Fisher exact test, and trend analysis using the Mann-Kendall test, and considered significant for P < .05. The number of VCF insertions increased 350% between January 1998 and January 2008. Consensus statements in favor of VCFs published by the Eastern Association for the Surgery of Trauma (EAST; July 2002) and the Society of Interventional Radiology (SIR; March 2006) led to a significant 138% and 122% increase in the use of VCFs over the next year (P < .05 respectively). CHEST guidelines (February 2008 and 2012) discouraging the use of VCFs led to an initial stabilization in the use of VCFs between 2008 and 2012, followed by a 16% decrease in use starting in March 2012 (P = NS). A decrease in Medicare reimbursement in 2008 led to no change in insertion rate (P = NS). Practice guidelines have helped to increase the rate of VCF utilization 3.5-fold between 1998 and 2008, but two more consensus statements against the use of VCFs published between 2008 and 2012 have led to only a 16% decrease in their use. Reimbursement rates have not significantly affected the rate of VCF implantation. More uniform consensus statements from multiple societies, along with the use of level I evidence, may be required in order to lead to a definitive change in practice.